Basic Information
| Provider Information | |||||||||
| NPI: | 1043564222 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEINER | ||||||||
| FirstName: | CASEY | ||||||||
| MiddleName: | ALLYN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 58 WILLIAM ST | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE CENTRE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115702526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164585156 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1329 BEACH CHANNEL DR | ||||||||
| Address2: | |||||||||
| City: | FAR ROCKAWAY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 116913211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183776850 | ||||||||
| FaxNumber: | 3472469670 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2012 | ||||||||
| LastUpdateDate: | 03/25/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 088747-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.