Provider Demographics
NPI:1679280135
Name:WEINBERG, PHILOMENA REGINA
Entity type:Individual
Prefix:
First Name:PHILOMENA
Middle Name:REGINA
Last Name:WEINBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 MORGANS TRCE
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-4510
Mailing Address - Country:US
Mailing Address - Phone:828-448-9692
Mailing Address - Fax:
Practice Address - Street 1:2924 TWO LAKE CIR
Practice Address - Street 2:
Practice Address - City:SOUTH FULTON
Practice Address - State:GA
Practice Address - Zip Code:30349-8208
Practice Address - Country:US
Practice Address - Phone:770-865-7722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst