Healthcare Provider Details

I. General information

NPI: 1689769226
Provider Name (Legal Business Name): RICHARD CRAIG WEIGEL LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 PINE LAKE AVENUE
LAPORTE IN
46350
US

IV. Provider business mailing address

PO BOX 1563
LAPORTE IN
46352
US

V. Phone/Fax

Practice location:
  • Phone: 219-324-6263
  • Fax: 219-326-6027
Mailing address:
  • Phone: 219-324-6263
  • Fax: 219-326-6027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34000261A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: