Provider Demographics
NPI:1003116831
Name:WEISS, MARK S (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:WEISS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1841 MERRICK AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-2736
Mailing Address - Country:US
Mailing Address - Phone:516-374-6577
Mailing Address - Fax:516-546-0654
Practice Address - Street 1:1841 MERRICK AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-2736
Practice Address - Country:US
Practice Address - Phone:516-374-6577
Practice Address - Fax:516-546-0654
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01970103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical