Healthcare Provider Details

I. General information

NPI: 1548474901
Provider Name (Legal Business Name): GERI DAWN WEITZMAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 03/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

941 E CHARLESTON RD STE 103
PALO ALTO CA
94303-4998
US

IV. Provider business mailing address

941 E CHARLESTON RD STE 103
PALO ALTO CA
94303-4998
US

V. Phone/Fax

Practice location:
  • Phone: 408-338-5638
  • Fax:
Mailing address:
  • Phone: 408-338-5638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY17963
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: