=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154497394
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHANIE FERSKO WEISS LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 106 STAGE RD
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10950-3513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-782-7220
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14 POINTS OF VIEW
-----------------------------------------------------
City | WARWICK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10990-2431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-782-7220
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | R024412
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------