Healthcare Provider Details

I. General information

NPI: 1841374022
Provider Name (Legal Business Name): EILEEN WIENER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 N VILLAGE AVE STE 100
ROCKVILLE CTR NY
11570
US

IV. Provider business mailing address

98120 QUEENS BLVD APT 1C
REGO PARK NY
11374
US

V. Phone/Fax

Practice location:
  • Phone: 516-594-0247
  • Fax: 718-830-0246
Mailing address:
  • Phone: 718-830-0246
  • Fax: 718-830-9088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberR0354411
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: