Healthcare Provider Details

I. General information

NPI: 1023591625
Provider Name (Legal Business Name): ZACHARY WEINERMAN BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 09/29/2026
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 INVERNESS CIR E
ENGLEWOOD CO
80112-5304
US

IV. Provider business mailing address

1150 GOLDEN CIR APT 311
GOLDEN CO
80401-3640
US

V. Phone/Fax

Practice location:
  • Phone: 720-799-6111
  • Fax:
Mailing address:
  • Phone: 720-799-6111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-48543
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-53035
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: