Provider Demographics
NPI:1700929080
Name:WEINER, DANIEL (MA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:WEINER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 N MAIN ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1972
Mailing Address - Country:US
Mailing Address - Phone:860-523-9473
Mailing Address - Fax:
Practice Address - Street 1:41 N MAIN ST
Practice Address - Street 2:SUITE 303
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1972
Practice Address - Country:US
Practice Address - Phone:860-677-0028
Practice Address - Fax:860-461-1514
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000361101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional