MEDICARE: DEENA WEISS PA

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
1	1041C0700X	Clinical Social Worker	SW3174	FL

General Provider Information

NPI Number	:	1407170483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEENA WEISS PA

Provider Business Mailing Address
First Line	:	2100 NE 197TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33179-3128
Country	:	US
Telephone Number	:	305-303-1274
Fax Number	:	305-933-1207

Provider Business Practice Location Address
First Line	:	2100 NE 197TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33179-3128
Country	:	US
Telephone Number	:	305-303-1274
Fax Number	:	305-933-1207

Authorized Official
Title or Position	:	CEO
Name	:	MS. DEENA WEISS
Credential	:	LCSW
Telephone Number	:	305-303-1274

Provider Enumeration Date	:	03/20/2010
Last Update Date	:	05/27/2010

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Directions to “DEENA WEISS PA ” Practice Location

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