1770555849 NPI number — DR. JOANNE G WEISS MSW LCSW MA MDIV DAR

Table of content: DR. JOANNE G WEISS MSW LCSW MA MDIV DAR (NPI 1770555849)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770555849 NPI number — DR. JOANNE G WEISS MSW LCSW MA MDIV DAR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEISS
Provider First Name:
JOANNE
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MSW LCSW MA MDIV DAR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770555849
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 162
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE ARIEL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18436-0162
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-352-4419
Provider Business Mailing Address Fax Number:
570-698-4013

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 W GROVE ST
Provider Second Line Business Practice Location Address:
PROFESSIONAL PLAZA
Provider Business Practice Location Address City Name:
CLARKS SUMMIT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-352-4419
Provider Business Practice Location Address Fax Number:
570-698-4013
Provider Enumeration Date:
02/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  CSW006812L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2099635 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000711767 . This is a "HMBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 11605420 . This is a "CAQH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 802133 . This is a "1ST PRIORITY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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