Healthcare Provider Details

I. General information

NPI: 1083604862
Provider Name (Legal Business Name): DEWIE WEINER SCHRIESHEIM MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEWIE WEINER MS

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 09/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 BEDFORD ST SUITE 19
LEXINGTON MA
02420-4646
US

IV. Provider business mailing address

4 DOVER LN
LEXINGTON MA
02421-6100
US

V. Phone/Fax

Practice location:
  • Phone: 781-861-7585
  • Fax: 781-862-2591
Mailing address:
  • Phone: 781-861-7585
  • Fax: 781-862-2591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102177
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: