Healthcare Provider Details

I. General information

NPI: 1649418005
Provider Name (Legal Business Name): JOLIE WEINGEROFF PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOLIE ISSA PHD

II. Dates (important events)

Enumeration Date: 01/23/2009
Last Update Date: 07/25/2021
Certification Date: 07/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

382 THAYER ST
PROVIDENCE RI
02906-1558
US

IV. Provider business mailing address

11 S ANGELL ST # 405
PROVIDENCE RI
02906-5206
US

V. Phone/Fax

Practice location:
  • Phone: 401-330-5882
  • Fax: 401-226-0137
Mailing address:
  • Phone: 401-330-5882
  • Fax: 401-226-0137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number019636
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS01616
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: