MEDICARE: NICHOLAS WEISS LMSW

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	6801091406	MI
2	104100000X	Social Worker	6801091406	MI

General Provider Information

NPI Number	:	1548514904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS WEISS LMSW

Provider Business Mailing Address
First Line	:	4800 N SCOTTSDALE RD STE 2500
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-7630
Country	:	US
Telephone Number	:	517-492-0517
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 TORREY RD STE 100
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-3327
Country	:	US
Telephone Number	:	517-492-0517
Fax Number	:

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

Provider Enumeration Date	:	11/06/2012
Last Update Date	:	05/06/2026

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Directions to “ NICHOLAS WEISS LMSW” Practice Location

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