Provider Demographics
NPI:1730659897
Name:VANESSA WEINBACH LLC
Entity type:Organization
Organization Name:VANESSA WEINBACH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:CAMILLE
Authorized Official - Last Name:WEINBACH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:203-343-4208
Mailing Address - Street 1:6 RIVERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-1306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:735 POST RD E
Practice Address - Street 2:2ND FL
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880
Practice Address - Country:US
Practice Address - Phone:203-343-4208
Practice Address - Fax:203-350-8286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-03
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)