MEDICARE: MRS. BONNIE 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	44SC00397200	NJ

General Provider Information

NPI Number	:	1902001852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BONNIE WEISS LCSW

Provider Business Mailing Address
First Line	:	1240 SUSSEX TPKE
Second Line	:	SUITE 4
City	:	RANDOLPH
State	:	NJ
Zip	:	07869-2944
Country	:	US
Telephone Number	:	973-285-0361
Fax Number	:

Provider Business Practice Location Address
First Line	:	1240 SUSSEX TPKE
Second Line	:	SUITE 4
City	:	RANDOLPH
State	:	NJ
Zip	:	07869-2944
Country	:	US
Telephone Number	:	973-285-0361
Fax Number	:

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

Provider Enumeration Date	:	06/20/2007
Last Update Date	:	07/08/2007

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