Provider Demographics
NPI:1871742577
Name:WEINBERG, RICHARD HENRY (LCPC)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:HENRY
Last Name:WEINBERG
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-1817
Mailing Address - Country:US
Mailing Address - Phone:708-383-1871
Mailing Address - Fax:
Practice Address - Street 1:1031 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-1817
Practice Address - Country:US
Practice Address - Phone:708-383-1871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.000604101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health