Healthcare Provider Details

I. General information

NPI: 1841704913
Provider Name (Legal Business Name): JAY WEINBERG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2017
Last Update Date: 11/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 S ALBION ST STE 1025
DENVER CO
80222-4047
US

IV. Provider business mailing address

1660 S ALBION ST STE 1025
DENVER CO
80222-4047
US

V. Phone/Fax

Practice location:
  • Phone: 303-870-5115
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberNLC0105840
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: