MEDICARE: JEANETTE WEISS M.A., M.ED.

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	103T00000X	Psychologist	PS006492L	PA

General Provider Information

NPI Number	:	1417316944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANETTE WEISS M.A., M.ED.

Provider Business Mailing Address
First Line	:	607 OAK SHADE AVE
Second Line	:
City	:	ELKINS PARK
State	:	PA
Zip	:	19027-1713
Country	:	US
Telephone Number	:	267-496-3885
Fax Number	:

Provider Business Practice Location Address
First Line	:	607 OAK SHADE AVE
Second Line	:
City	:	ELKINS PARK
State	:	PA
Zip	:	19027-1713
Country	:	US
Telephone Number	:	267-496-3885
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2016
Last Update Date	:	02/11/2016

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