Provider Demographics
NPI:1841313087
Name:WEISNER, LINDSAY SHERA (PSYD)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:SHERA
Last Name:WEISNER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:SHERA
Other - Last Name:KALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11223 75TH AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-7407
Mailing Address - Country:US
Mailing Address - Phone:202-491-8508
Mailing Address - Fax:
Practice Address - Street 1:329 E 62ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-7705
Practice Address - Country:US
Practice Address - Phone:212-838-4333
Practice Address - Fax:212-838-7158
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP54487103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP54487OtherPSYCHOLOGY