Provider Demographics
NPI:1770073033
Name:WEINER, JENNIFER LAUREN (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LAUREN
Last Name:WEINER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ASHCROFT RD
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-1413
Mailing Address - Country:US
Mailing Address - Phone:202-329-2651
Mailing Address - Fax:
Practice Address - Street 1:15 ASHCROFT RD
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-1413
Practice Address - Country:US
Practice Address - Phone:202-329-2651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-12
Last Update Date:2018-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9112103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling