MEDICARE: MR. JAMES A WEISS LCSW

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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01634439	OTHER	IL	BLUECROSS BLUE SHIELD

General Provider Information

NPI Number	:	1841392578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES A WEISS LCSW

Provider Business Mailing Address
First Line	:	8846 FORESTVIEW RD
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60203-1925
Country	:	US
Telephone Number	:	847-329-9589
Fax Number	:	847-329-9589

Provider Business Practice Location Address
First Line	:	1609 SHERMAN AVE
Second Line	:	SUITE 319
City	:	EVANSTON
State	:	IL
Zip	:	60201-3753
Country	:	US
Telephone Number	:	847-329-9589
Fax Number	:	847-329-9589

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

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	07/08/2007

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Directions to “ MR. JAMES A WEISS LCSW” Practice Location

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