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General NPI Number Information
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NPI Number | 1285298844
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Entity Type | Individual
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Provider Name | JODY-ANN WEISE LMSW
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Gender | Female
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Dates
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Enumeration Date | 04/29/2019
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 324 FRENCH ST
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City | WATERTOWN
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State | CT
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Zip | 06795-2929
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Country | US
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Telephone | 860-945-4810
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Fax |
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Provider Business Mailing Address
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Address Line | 160 W WASHINGTON ST APT B1
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City | BRISTOL
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State | CT
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Zip | 06010-5448
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Country | US
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Telephone | 860-997-0688
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 7441
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License Number State | CT
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