MEDICARE: JENNIFER LISA WEINER M.S., C.G.C.

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	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1225250574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LISA WEINER M.S., C.G.C.

Provider Business Mailing Address
First Line	:	3 TOWN HOUSE DR
Second Line	:
City	:	NEWTONVILLE
State	:	MA
Zip	:	02460-1914
Country	:	US
Telephone Number	:	617-965-5777
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 FRUIT ST
Second Line	:	YAWKEY 4200
City	:	BOSTON
State	:	MA
Zip	:	02114-2621
Country	:	US
Telephone Number	:	617-724-2229
Fax Number	:

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	07/08/2007

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