Provider Demographics
NPI:1053437624
Name:WEINER, ROBERTA E (LCPC)
Entity type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:E
Last Name:WEINER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:ROBERTA
Other - Middle Name:
Other - Last Name:WEINER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:905 HASTINGS LANE
Mailing Address - Street 2:
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133
Mailing Address - Country:US
Mailing Address - Phone:630-289-9888
Mailing Address - Fax:630-513-4277
Practice Address - Street 1:1750 E MAIN ST
Practice Address - Street 2:SUITE 40
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174
Practice Address - Country:US
Practice Address - Phone:630-513-6277
Practice Address - Fax:630-513-4277
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
0034940431Medicare UPIN