Provider Demographics
NPI:1114473923
Name:WEINBERG, MICHAEL (PSYD, LMHC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:WEINBERG
Suffix:
Gender:M
Credentials:PSYD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 RETROP RD
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-3632
Mailing Address - Country:US
Mailing Address - Phone:617-501-4099
Mailing Address - Fax:
Practice Address - Street 1:4 HARTFORD ST STE 201
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02461-1553
Practice Address - Country:US
Practice Address - Phone:617-764-9271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA11803103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical