Provider Demographics
NPI:1538193461
Name:WENER, BRIAN (PSYD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:WENER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1645
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03802-1645
Mailing Address - Country:US
Mailing Address - Phone:603-431-1294
Mailing Address - Fax:
Practice Address - Street 1:118 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-3787
Practice Address - Country:US
Practice Address - Phone:603-431-1294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH285103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH06Y008384NH01OtherANTHEM BLUE CROSS
NH80002273Medicaid
NHNH2273Medicare ID - Type Unspecified