Healthcare Provider Details

I. General information

NPI: 1225250574
Provider Name (Legal Business Name): JENNIFER LISA WEINER M.S., C.G.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST YAWKEY 4200
BOSTON MA
02114-2621
US

IV. Provider business mailing address

3 TOWN HOUSE DR
NEWTONVILLE MA
02460-1914
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-2229
  • Fax:
Mailing address:
  • Phone: 617-965-5777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: