Doctor Name: | MRS. ROBERTA E WEINER |
NPI Number: | 1053437624 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCPC |
License Number: | |
Business Practice Address: | 1750 E Main St Suite 40 St Charles, IL - 60174 |
Business Phone Number: | 6305136277 |
Business Fax Number: | 6305134277 |
Mailing Address: | 905 Hastings Lane, HANOVER PARK |
State: | IL |
Postal Code: | 60133 |
Phone Number: | 6302899888 |
Fax Number: | 6305134277 |
NPI Enumeration Date: | 03/22/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |