Active NPI
Elayne J Weiner, EDD
- Psychologist
- Marblehead, MA
National Provider Identifier
1104885383
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 410
- Practice address
- 1 Widger Rd
Suite 305
Marblehead, MA 01945 - Phone
- (781) 639-0457
- Fax
- (781) 639-3089
- NPI assigned
- Mar 17, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 410 | MA | Primary |
Addresses
Primary practice location
1 Widger Rd
Suite 305
Marblehead, MA 01945
Mailing address
1 Widger Rd
Suite 305
Marblehead, MA 01945
Phone (781) 639-0457
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 410 | MA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142553600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1278547200000",
"number": "1104885383",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 WIDGER RD",
"address_2": "SUITE 305",
"city": "MARBLEHEAD",
"state": "MA",
"postal_code": "01945",
"telephone_number": "781-639-0457",
"fax_number": "781-639-3089"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 WIDGER RD",
"address_2": "SUITE 305",
"city": "MARBLEHEAD",
"state": "MA",
"postal_code": "01945",
"telephone_number": "781-639-0457",
"fax_number": "781-639-3089"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEINER",
"first_name": "ELAYNE",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "EDD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-03-17",
"last_updated": "2010-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MA",
"license": "410",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marblehead, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.