Basic Information
| Provider Information | |||||||||
| NPI: | 1508972845 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WIENER | ||||||||
| FirstName: | CRAIG | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | ED.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 87 WILLIAM ST | ||||||||
| Address2: | SOCIAL SERVICES | ||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016092136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087564825 | ||||||||
| FaxNumber: | 5088607990 | ||||||||
| Practice Location | |||||||||
| Address1: | 48 CEDAR ST. | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 001090010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087564825 | ||||||||
| FaxNumber: | 5087923519 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 02/05/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 2580 | MA | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 1001040 | 01 | MA | BEAON HEALTH STATEGIES | OTHER | 1300709 | 05 | MA | MEDICAID | 24846 | 01 | MA | CIGNA | OTHER | W02706 | 01 | MA | BLUE CROSS BLUE SHIELD | OTHER | 986777801 | 01 | MA | NETWORK HEALTH | OTHER | 052178000 | 01 | MA | MAGELLAN BEHAVIORAL HEALT | OTHER | 1001250 | 01 | MA | BEACON-GROUP | OTHER | 716664 | 01 | MA | TUFTS HEALTH PLAN | OTHER | 0300050 | 05 | MA | MEDICAID | 042485308 | 01 | MA | NETWORK HEALTH-GROUP | OTHER | Y10141 | 01 | MA | BCBS-GROUP | OTHER | 0508977 | 01 | MA | MEDICAID | OTHER | W10560 | 01 | MA | BCBS | OTHER |