MEDICARE: DAVID WEINBERG LCSW

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	I.1100131	OH
2	1041C0700X	Clinical Social Worker	2014023114	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134370984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID WEINBERG LCSW

Provider Business Mailing Address
First Line	:	7710 CARONDELET AVE STE 204
Second Line	:
City	:	CLAYTON
State	:	MO
Zip	:	63105-3319
Country	:	US
Telephone Number	:	314-439-1005
Fax Number	:

Provider Business Practice Location Address
First Line	:	7710 CARONDELET AVE STE 204
Second Line	:
City	:	CLAYTON
State	:	MO
Zip	:	63105-3319
Country	:	US
Telephone Number	:	314-439-1005
Fax Number	:

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

Provider Enumeration Date	:	10/09/2008
Last Update Date	:	07/22/2015

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