Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 4576 | FL |
Y | 103T00000X | Psychologist | 4576 | FL |
N | 103TP0814X | Psychoanalysis | 4576 | FL |
NPI | 1003972167 |
---|---|
Provider Name | Eric Scott Wiener |
First Address | Orlando, FL 32819-5258 |
Second Address | Orlando, FL 32819-5258 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2006 |
Last Update Date | 20/08/2010 |