Healthcare Provider Details

I. General information

NPI: 1972722627
Provider Name (Legal Business Name): JEFFREY ADAM WEISSLITZ PSYD, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 GORDON AVE
LAWRENCEVILLE NJ
08648-1033
US

IV. Provider business mailing address

22 GORDON AVE PO BOX 6573
LAWRENCEVILLE NJ
08648-1033
US

V. Phone/Fax

Practice location:
  • Phone: 609-844-0452
  • Fax: 609-684-0518
Mailing address:
  • Phone: 609-844-0452
  • Fax: 609-684-0518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00302600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: