MEDICARE: DR. JEFFREY RALPH WEISE PH.D.

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	103TC1900X	Counseling Psychologist	PS008655L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	646581	OTHER	PA	HIGHMARK BLUE SHIELD

General Provider Information

NPI Number	:	1912979410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY RALPH WEISE PH.D.

Provider Business Mailing Address
First Line	:	5869 FORBES AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15217-1601
Country	:	US
Telephone Number	:	412-422-9160
Fax Number	:	412-422-8180

Provider Business Practice Location Address
First Line	:	5869 FORBES AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15217-1601
Country	:	US
Telephone Number	:	412-422-9160
Fax Number	:	412-422-8180

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

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

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