Provider Demographics
NPI:1104963628
Name:WEINSTEIN, ALLA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ALLA
Middle Name:
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:ALLA
Other - Middle Name:
Other - Last Name:VAYNSHTEYN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:20517 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-1241
Mailing Address - Country:US
Mailing Address - Phone:718-229-0216
Mailing Address - Fax:
Practice Address - Street 1:7150 PARSONS BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11365-4131
Practice Address - Country:US
Practice Address - Phone:718-591-6750
Practice Address - Fax:718-591-4397
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR052805-12084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02438475Medicaid
NY05747Medicare ID - Type UnspecifiedPSYCHOTHERAPY