MEDICARE: CLEA WEISS

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	1041C0700X	Clinical Social Worker	07442	NJ

General Provider Information

NPI Number	:	1831228584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLEA WEISS

Provider Business Mailing Address
First Line	:	46 BEECH RD
Second Line	:
City	:	RANDOLPH
State	:	NJ
Zip	:	07869-4525
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	659 EAGLE ROCK AVE
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-2138
Country	:	US
Telephone Number	:	973-895-2102
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	07/08/2007

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Directions to “ CLEA WEISS ” Practice Location

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