Provider Demographics
NPI:1679626352
Name:WEINER, DANA M (LCSW)
Entity type:Individual
Prefix:MS
First Name:DANA
Middle Name:M
Last Name:WEINER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:DANA
Other - Middle Name:M
Other - Last Name:SHAMASH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:34 CRESCENT ST
Mailing Address - Street 2:APT #2G
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06906-1838
Mailing Address - Country:US
Mailing Address - Phone:203-722-6138
Mailing Address - Fax:
Practice Address - Street 1:80 FERRY BLVD
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615-6079
Practice Address - Country:US
Practice Address - Phone:203-378-1654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0063041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical