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General NPI Number Information
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NPI Number | 1679942114
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Entity Type | Individual
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Provider Name | ANDREA WEISSE
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Gender | Female
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Dates
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Enumeration Date | 09/15/2015
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Last Update Date | 01/27/2020
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Provider Practice Location Address
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Address Line | 408 MAIN ST
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City | CENTER MORICHES
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State | NY
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Zip | 11934-3518
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Country | US
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Telephone | 631-396-1800
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 706
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City | SHIRLEY
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State | NY
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Zip | 11967-0706
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Country | US
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Telephone | 631-395-1800
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Fax | 631-399-1550
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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 |
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License Number State |
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