Healthcare Provider Details

I. General information

NPI: 1841261781
Provider Name (Legal Business Name): GAIL JOANN WEISSERT MSW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 09/24/2023
Certification Date: 09/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23627 WILLOW POND RD
DENTON MD
21629-2104
US

IV. Provider business mailing address

23627 WILLOW POND RD
DENTON MD
21629-2104
US

V. Phone/Fax

Practice location:
  • Phone: 410-479-0434
  • Fax: 410-479-2723
Mailing address:
  • Phone: 410-479-0434
  • Fax: 410-479-2723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number02976
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: