Provider Demographics
NPI:1649306846
Name:WEINER, S SCOTT (PHD, JD)
Entity type:Individual
Prefix:DR
First Name:S
Middle Name:SCOTT
Last Name:WEINER
Suffix:
Gender:M
Credentials:PHD, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12845 POINTE DEL MAR WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-3862
Mailing Address - Country:US
Mailing Address - Phone:858-259-0599
Mailing Address - Fax:
Practice Address - Street 1:12845 POINTE DEL MAR WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-3862
Practice Address - Country:US
Practice Address - Phone:858-259-0599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-24
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 9365103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical