Healthcare Provider Details

I. General information

NPI: 1912964958
Provider Name (Legal Business Name): NEIL WEINER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 02/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2152 S VINEYARD SUITE 110
MESA AZ
85210-6871
US

IV. Provider business mailing address

2152 S VINEYARD 110
MESA AZ
85210-6871
US

V. Phone/Fax

Practice location:
  • Phone: 480-491-5770
  • Fax: 480-507-3317
Mailing address:
  • Phone: 480-491-5770
  • Fax: 480-507-3317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1090
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: