Healthcare Provider Details

I. General information

NPI: 1316150717
Provider Name (Legal Business Name): JERROLD WEINER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 FLUME ST STE 110
CHICO CA
95928-5400
US

IV. Provider business mailing address

330 FLUME ST STE 110
CHICO CA
95928-5400
US

V. Phone/Fax

Practice location:
  • Phone: 530-345-9777
  • Fax: 530-898-1204
Mailing address:
  • Phone: 530-345-9777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A6235
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW10612
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: