Healthcare Provider Details

I. General information

NPI: 1861438020
Provider Name (Legal Business Name): RICHARD ALAN WEINER PH.D., ABPP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3738 MANAYUNK AVE
PHILADELPHIA PA
19128-3705
US

IV. Provider business mailing address

3738 MANAYUNK AVE
PHILADELPHIA PA
19128-3705
US

V. Phone/Fax

Practice location:
  • Phone: 999-999-9999
  • Fax:
Mailing address:
  • Phone: 215-487-3792
  • Fax: 215-487-3792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPS-005710-L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS-005710-L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPS-005710-L
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS-005710-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: