Healthcare Provider Details

I. General information

NPI: 1639098510
Provider Name (Legal Business Name): PAUL G WEIL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10882 EDGEWOOD RD
HARRISON OH
45030-1724
US

IV. Provider business mailing address

4647 MITCHELL WOODS DR
CLEVES OH
45002-9658
US

V. Phone/Fax

Practice location:
  • Phone: 513-236-1359
  • Fax:
Mailing address:
  • Phone: 513-417-0708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number3125079
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: