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NPI Code Detail

MEDICARE: MS. KRISTINE A WEIDNER LCSW

MEDICARE: MS. KRISTINE A WEIDNER 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
11041C0700XClinical Social Worker010161CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1313547OTHERNYUNITED BEHAVIORAL HEALTH
2549454OTHERNYVALUE OPTIONS

General Provider Information

NPI Number : 1871535914
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KRISTINE A WEIDNER LCSW
Provider Business Mailing Address
First Line : 200 STATE ST
Second Line :
City : NORTH HAVEN
State : CT
Zip : 06473-2207
Country : US
Telephone Number : 518-466-4408
Fax Number :
Provider Business Practice Location Address
First Line : 200 STATE ST
Second Line :
City : NORTH HAVEN
State : CT
Zip : 06473-2207
Country : US
Telephone Number : 518-466-4408
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2006
Last Update Date : 04/14/2025

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