Basic Information
| Provider Information | |||||||||
| NPI: | 1902335318 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEINER | ||||||||
| FirstName: | JESSIE | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | MSW, CAP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8800 49TH ST N STE 106 | ||||||||
| Address2: | |||||||||
| City: | PINELLAS PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337825332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275440044 | ||||||||
| FaxNumber: | 7275450125 | ||||||||
| Practice Location | |||||||||
| Address1: | 8800 49TH ST. N STE 106 | ||||||||
| Address2: | |||||||||
| City: | PINELLAS PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275440044 | ||||||||
| FaxNumber: | 7275450125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.