Basic Information
| Provider Information | |||||||||
| NPI: | 1942524905 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEINTRAUB | ||||||||
| FirstName: | GINA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2801 LOMBARD AVE | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982013619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252123993 | ||||||||
| FaxNumber: | 4252593073 | ||||||||
| Practice Location | |||||||||
| Address1: | 2801 LOMBARD AVE | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982013619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252123993 | ||||||||
| FaxNumber: | 4252593073 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2010 | ||||||||
| LastUpdateDate: | 03/19/2010 | ||||||||
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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 | 101YM0800X | RC00059238 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.