Healthcare Provider Details

I. General information

NPI: 1548514904
Provider Name (Legal Business Name): NICHOLAS WEISS LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 TORREY RD STE 100
FENTON MI
48430-3327
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7630
US

V. Phone/Fax

Practice location:
  • Phone: 517-492-0517
  • Fax:
Mailing address:
  • Phone: 517-492-0517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801091406
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801091406
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: