MEDICARE: MR. SCOTT WEISENBERGER LPC

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	101YP2500X	Professional Counselor	PC002751	PA

General Provider Information

NPI Number	:	1760502827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SCOTT WEISENBERGER LPC

Provider Business Mailing Address
First Line	:	111 N 49TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-2718
Country	:	US
Telephone Number	:	215-471-2314
Fax Number	:	215-471-2897

Provider Business Practice Location Address
First Line	:	111 N 49TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-2718
Country	:	US
Telephone Number	:	215-471-2314
Fax Number	:	215-471-2897

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

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	07/08/2007

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Directions to “ MR. SCOTT WEISENBERGER LPC” Practice Location

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