Provider Demographics
NPI:1285108233
Name:VINEBERG, DINA
Entity type:Individual
Prefix:
First Name:DINA
Middle Name:
Last Name:VINEBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22664 SYLVAN WAY
Mailing Address - Street 2:
Mailing Address - City:MONTE RIO
Mailing Address - State:CA
Mailing Address - Zip Code:95462-9797
Mailing Address - Country:US
Mailing Address - Phone:707-210-8445
Mailing Address - Fax:
Practice Address - Street 1:22664 SYLVAN WAY
Practice Address - Street 2:
Practice Address - City:MONTE RIO
Practice Address - State:CA
Practice Address - Zip Code:95462-9797
Practice Address - Country:US
Practice Address - Phone:707-210-8445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-13
Last Update Date:2019-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15000101YM0800X
CA5299101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health