Provider Demographics
NPI:1578379525
Name:WIENER, LILA GRACE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:LILA
Middle Name:GRACE
Last Name:WIENER
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 GRENVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-2158
Mailing Address - Country:US
Mailing Address - Phone:917-209-2665
Mailing Address - Fax:
Practice Address - Street 1:301 E 94TH ST APT 7E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-0372
Practice Address - Country:US
Practice Address - Phone:917-209-2665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-05
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY126055104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker