MEDICARE: ELLEN WEISBERG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	PS-006488-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	731333	OTHER	PA	HIGHMARK BLUE SHIELD
2	1578591350	OTHER		NPI
3	50001372	OTHER	PA	CAPITAL BLUE CROSS

General Provider Information

NPI Number	:	1457384943
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELLEN WEISBERG

Provider Business Mailing Address
First Line	:	325 S 20TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-6533
Country	:	US
Telephone Number	:	215-985-1947
Fax Number	:	215-985-3633

Provider Business Practice Location Address
First Line	:	325 S 20TH ST
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19103-6533
Country	:	US
Telephone Number	:	215-985-1947
Fax Number	:	215-985-3633

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	ELLEN VICKY WEISBERG
Credential	:
Telephone Number	:	215-985-1947

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	08/22/2020

Similar Medicare Providers

1578591350 — MS. ELLEN VICKY WEISBERG M.A.
Practice Location Address:

325 S 20TH ST
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Practice Phone: 215-985-1947
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1093760563 — DR. GAIL GREENSPAN M.D.
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1528001971 — DR. LAWRENCE ROBERT GRIFFIN PH.D.
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1932143021 — DR. ESTHER J. NASH MD
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Directions to “ELLEN WEISBERG ” Practice Location

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