Healthcare Provider Details

I. General information

NPI: 1770073033
Provider Name (Legal Business Name): JENNIFER LAUREN WEINER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2018
Last Update Date: 05/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 ASHCROFT RD
SHARON MA
02067-1413
US

IV. Provider business mailing address

15 ASHCROFT RD
SHARON MA
02067-1413
US

V. Phone/Fax

Practice location:
  • Phone: 202-329-2651
  • Fax:
Mailing address:
  • Phone: 202-329-2651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number9112
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: