MEDICARE: LAURA H WEINSTOCK PHD CLINICAL PSYCHOL

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	103TC0700X	Clinical Psychologist	002672	CT
2	103TC0700X	Clinical Psychologist	2010033643	MO

General Provider Information

NPI Number	:	1952488025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA H WEINSTOCK PHD CLINICAL PSYCHOL

Provider Business Mailing Address
First Line	:	7710 CARONDELET AVE
Second Line	:	SUITE 503
City	:	CLAYTON
State	:	MO
Zip	:	63105-3319
Country	:	US
Telephone Number	:	314-727-7726
Fax Number	:	314-727-7725

Provider Business Practice Location Address
First Line	:	7710 CARONDELET AVE
Second Line	:	SUITE 503
City	:	CLAYTON
State	:	MO
Zip	:	63105-3319
Country	:	US
Telephone Number	:	314-727-7726
Fax Number	:	314-727-7725

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	05/19/2011

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