Provider Demographics
NPI:1215939111
Name:PYNE-WEISSMAN, SHAREN LEIGH (LCSW, LMFT, APN)
Entity type:Individual
Prefix:MRS
First Name:SHAREN
Middle Name:LEIGH
Last Name:PYNE-WEISSMAN
Suffix:
Gender:F
Credentials:LCSW, LMFT, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 LINWOOD AVE E
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-3825
Mailing Address - Country:US
Mailing Address - Phone:201-835-3605
Mailing Address - Fax:201-599-9729
Practice Address - Street 1:101 CEDAR LN
Practice Address - Street 2:STE 202
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4417
Practice Address - Country:US
Practice Address - Phone:201-835-3605
Practice Address - Fax:201-599-9729
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC00033500104100000X
NJ37F100134000106H00000X
NJ26N006756900163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
634479Medicare ID - Type Unspecified
506163Medicare UPIN