Provider Demographics
NPI:1811069958
Name:WEINER, MARC M (PHD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:M
Last Name:WEINER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 LYNNWOOD ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-1662
Mailing Address - Country:US
Mailing Address - Phone:508-993-5684
Mailing Address - Fax:
Practice Address - Street 1:261 UNION ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-5949
Practice Address - Country:US
Practice Address - Phone:508-997-0096
Practice Address - Fax:508-997-0096
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2329103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA407786OtherBLUE CHIP RHODE ISLAND
MAW02582OtherBLUE CROSS BLUE SHIELD
MAW02582Medicare ID - Type Unspecified