Provider Demographics
NPI:1285779595
Name:WEINER, JODI (PHD)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:WEINER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22030 CLARENDON ST
Mailing Address - Street 2:#214
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6316
Mailing Address - Country:US
Mailing Address - Phone:818-992-9000
Mailing Address - Fax:
Practice Address - Street 1:22030 CLARENDON ST
Practice Address - Street 2:#214
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-6316
Practice Address - Country:US
Practice Address - Phone:818-992-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 16141103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent