Healthcare Provider Details

I. General information

NPI: 1063512200
Provider Name (Legal Business Name): CATHARINE LOUISE WEISS PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4538 EDMONDSON AVE
BALTIMORE MD
21229-1506
US

IV. Provider business mailing address

PO BOX 64888
BALTIMORE MD
21264-4888
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-2273
  • Fax: 410-328-2273
Mailing address:
  • Phone: 301-631-8101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number04304
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: