Provider Demographics
NPI:1053520387
Name:WEINER, JOAN LORI (LCSW)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:LORI
Last Name:WEINER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 W 72ND ST
Mailing Address - Street 2:#1607
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-3498
Mailing Address - Country:US
Mailing Address - Phone:212-877-5040
Mailing Address - Fax:212-877-5040
Practice Address - Street 1:154 W 76TH ST
Practice Address - Street 2:#4
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-8420
Practice Address - Country:US
Practice Address - Phone:212-595-9788
Practice Address - Fax:212-877-5040
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR035670-1102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN1I201Medicare ID - Type Unspecified