Provider Demographics
NPI:1740346840
Name:WEINSTEIN, TOD (LCSW)
Entity type:Individual
Prefix:MR
First Name:TOD
Middle Name:
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 COTTMAN AVE APT B371
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-3080
Mailing Address - Country:US
Mailing Address - Phone:215-805-9280
Mailing Address - Fax:
Practice Address - Street 1:800 COTTMAN AVE APT B371
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19111-3080
Practice Address - Country:US
Practice Address - Phone:215-805-9280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW001636L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA645518Medicare ID - Type Unspecified