Healthcare Provider Details

I. General information

NPI: 1235052739
Provider Name (Legal Business Name): NICHOLAS WEISENBURGER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

396 LAIDLEY ST
SAN FRANCISCO CA
94131-3036
US

IV. Provider business mailing address

396 LAIDLEY ST
SAN FRANCISCO CA
94131-3036
US

V. Phone/Fax

Practice location:
  • Phone: 415-351-9651
  • Fax:
Mailing address:
  • Phone: 415-351-9651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number21408
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number160282
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: