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NPI Code Detail

MEDICARE: MR. STEPHEN JEFFREY WEISS MSW

MEDICARE: MR. STEPHEN JEFFREY WEISS MSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker1015405MA

General Provider Information

NPI Number : 1174565105
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. STEPHEN JEFFREY WEISS MSW
Provider Business Mailing Address
First Line : 14832 N EL FRIO ST
Second Line :
City : EL MIRAGE
State : AZ
Zip : 85335-6952
Country : US
Telephone Number : 623-242-6006
Fax Number :
Provider Business Practice Location Address
First Line : 3450 N 3RD ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-2331
Country : US
Telephone Number : 602-265-8338
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2006
Last Update Date : 07/08/2007

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