Provider Demographics
NPI:1831421254
Name:WEINTRAUB, PATRICK MICHAEL (LMHC)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:MICHAEL
Last Name:WEINTRAUB
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HAMPDEN DR
Mailing Address - Street 2:APT 1-B
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062
Mailing Address - Country:US
Mailing Address - Phone:631-672-1331
Mailing Address - Fax:
Practice Address - Street 1:90 NEW STATE HWY
Practice Address - Street 2:BPPA
Practice Address - City:RAYNHAM
Practice Address - State:MA
Practice Address - Zip Code:02767-1433
Practice Address - Country:US
Practice Address - Phone:631-672-1331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6572101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health