Healthcare Provider Details

I. General information

NPI: 1922344027
Provider Name (Legal Business Name): HARVEY MILTON WEITZEL D. MIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2012
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 WOLFPIT AVE
NORWALK CT
06851-2647
US

IV. Provider business mailing address

250 WOLFPIT AVE
NORWALK CT
06851-2647
US

V. Phone/Fax

Practice location:
  • Phone: 203-956-5812
  • Fax:
Mailing address:
  • Phone: 203-956-5812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPASTORAL COUNSELOR
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberPASTORAL PSYCHOTHERA
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: