Healthcare Provider Details

I. General information

NPI: 1174565105
Provider Name (Legal Business Name): STEPHEN JEFFREY WEISS MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 N 3RD ST
PHOENIX AZ
85012-2331
US

IV. Provider business mailing address

14832 N EL FRIO ST
EL MIRAGE AZ
85335-6952
US

V. Phone/Fax

Practice location:
  • Phone: 602-265-8338
  • Fax:
Mailing address:
  • Phone: 623-242-6006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1015405
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: