Healthcare Provider Details

I. General information

NPI: 1669799334
Provider Name (Legal Business Name): TARA LEIGH WEINBERG M.S. ED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2010
Last Update Date: 06/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 PROVIDENCE HWY
NORWOOD MA
02062-2624
US

IV. Provider business mailing address

55 PROVIDENCE HWY
NORWOOD MA
02062-2624
US

V. Phone/Fax

Practice location:
  • Phone: 774-206-1125
  • Fax: 774-628-9657
Mailing address:
  • Phone: 774-206-1125
  • Fax: 774-628-9657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: