MEDICARE: MS. DEWIE WEINER SCHRIESHEIM MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	102177	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	WEP01344	OTHER	MA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1083604862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEWIE WEINER SCHRIESHEIM MS

Provider Business Mailing Address
First Line	:	4 DOVER LN
Second Line	:
City	:	LEXINGTON
State	:	MA
Zip	:	02421-6100
Country	:	US
Telephone Number	:	781-861-7585
Fax Number	:	781-862-2591

Provider Business Practice Location Address
First Line	:	76 BEDFORD ST
Second Line	:	SUITE 19
City	:	LEXINGTON
State	:	MA
Zip	:	02420-4646
Country	:	US
Telephone Number	:	781-861-7585
Fax Number	:	781-862-2591

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	09/05/2010

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