Healthcare Provider Details

I. General information

NPI: 1205057213
Provider Name (Legal Business Name): SUSAN WEINER M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 W THOMAS RD
PHOENIX AZ
85015-6051
US

IV. Provider business mailing address

6109 N 12TH ST
PHOENIX AZ
85014-1716
US

V. Phone/Fax

Practice location:
  • Phone: 602-764-8045
  • Fax:
Mailing address:
  • Phone: 602-764-8045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: