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General NPI Number Information
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NPI Number | 1568536936
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Entity Type | Individual
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Provider Name | JUDITH MYRNA WEISS LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1492 RICHMOND RD
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City | STATEN ISLAND
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State | NY
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Zip | 10304-2319
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Country | US
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Telephone | 718-720-8169
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Fax | 718-351-4656
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Provider Business Mailing Address
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Address Line | 47 E 87TH ST
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City | NEW YORK
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State | NY
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Zip | 10128-1005
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Country | US
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Telephone | 212-348-4274
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Fax | 718-351-4656
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | PR21955
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License Number State | NY
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