Individual
MRS. JACQUELINE AMANDA WEINER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
3532 JAMES STREET, SYRACUSE, NY 13206
(315) 463-9413
(315) 463-9419
Mailing address
3532 JAMES STREET, SYRACUSE, NY 13206
(315) 463-9413
(315) 463-9419
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
001626
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336163963
—
NY
Enumeration date
06/26/2018
Last updated
02/27/2020
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