Healthcare Provider Details

I. General information

NPI: 1659628006
Provider Name (Legal Business Name): JOAN WEILL LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2012
Last Update Date: 09/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9475 LOTTSFORD RD SUITE 250
LARGO MD
20774-5357
US

IV. Provider business mailing address

9475 LOTTSFORD RD SUITE 250
LARGO MD
20774-5357
US

V. Phone/Fax

Practice location:
  • Phone: 301-636-6504
  • Fax: 301-636-6509
Mailing address:
  • Phone: 301-636-6504
  • Fax: 301-636-6509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14310
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: