Healthcare Provider Details

I. General information

NPI: 1902097785
Provider Name (Legal Business Name): FENIA WEILLER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 07/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 SCHOOL ST LL STE. A
RYE NY
10580-2952
US

IV. Provider business mailing address

129 N. RIDGE ST.
RYE BROOK NY
10573
US

V. Phone/Fax

Practice location:
  • Phone: 203-550-6582
  • Fax:
Mailing address:
  • Phone: 914-939-5064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number002561
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number002561
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number002561
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number015707
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: