Healthcare Provider Details

I. General information

NPI: 1376011635
Provider Name (Legal Business Name): KIM WEINER PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4232 NORTHERN PIKE STE 304
MONROEVILLE PA
15146-2721
US

IV. Provider business mailing address

411 BRADDOCK RD
PITTSBURGH PA
15221-3731
US

V. Phone/Fax

Practice location:
  • Phone: 412-967-0610
  • Fax: 412-968-0527
Mailing address:
  • Phone: 412-605-7526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPS008245L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: