Provider Demographics
NPI:1174562631
Name:WEINSTEIN, CHARLES D (PHD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:D
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:2275 HUNTINGTON DR # 352
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2640
Mailing Address - Country:US
Mailing Address - Phone:818-995-4840
Mailing Address - Fax:626-441-6940
Practice Address - Street 1:2200 W MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-1734
Practice Address - Country:US
Practice Address - Phone:818-995-4840
Practice Address - Fax:626-441-6940
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY8953103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPJ0089531Medicaid
CAPJ0089531Medicaid
CACP8953Medicare ID - Type Unspecified