Individual provider Active NPI

Glenn Weiner, PHD

  • Clinical Psychologist
  • Richmond, VA
National Provider Identifier
1710905336
Registry record updated Mar 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
0801000430 Issued in VA
Practice address
703 N Courthouse Rd
Suite 101
Richmond, VA 23236-4069
Phone
(804) 794-4482
Fax
(804) 379-7578
NPI assigned
Jul 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 0801000430 VA Primary

Addresses

Primary practice location

703 N Courthouse Rd
Suite 101
Richmond, VA 23236-4069

Mailing address

703 N Courthouse Rd
Suite 101
Richmond, VA 23236-4069
Phone (804) 794-4482

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041101001110 VA Practitioner - Clinical Psychologist 3476515404 Practice locations: Richmond, VA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Temple University School of Medicine, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

703 N Courthouse Rd
Suite 101
North Chesterfield, VA 23236-4069

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
0801000430VAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Dominion Behavioral Healthcare PastSince Jan 5, 1999 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205452800000",
    "number": "1710905336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "703 N COURTHOUSE RD",
            "address_2": "SUITE 101",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232364069",
            "telephone_number": "804-794-4482",
            "fax_number": "804-379-7578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 N COURTHOUSE RD",
            "address_2": "SUITE 101",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232364069",
            "telephone_number": "804-794-4482",
            "fax_number": "804-379-7578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEINER",
        "first_name": "GLENN",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2008-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0801000430",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond, VA

Sources for this page

Verify at the official NPI Registry.