Provider Demographics
NPI:1649306838
Name:WEINER, LORRAINE DENISE
Entity type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:DENISE
Last Name:WEINER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LORRAINE
Other - Middle Name:DENISE
Other - Last Name:MINTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:330 S MAGNOLIA AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-5290
Mailing Address - Country:US
Mailing Address - Phone:619-401-7736
Mailing Address - Fax:
Practice Address - Street 1:330 S MAGNOLIA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-5290
Practice Address - Country:US
Practice Address - Phone:619-401-7736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMT20598106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist