Provider Demographics
NPI:1053493080
Name:WEITZ, CATHY (ATR)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:WEITZ
Suffix:
Gender:F
Credentials:ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 SPRING AVE
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-3946
Mailing Address - Country:US
Mailing Address - Phone:215-951-8122
Mailing Address - Fax:
Practice Address - Street 1:4200 MONUMENT ROAD
Practice Address - Street 2:BELMONT CENTER
Practice Address - City:PHILA.
Practice Address - State:PA
Practice Address - Zip Code:19131
Practice Address - Country:US
Practice Address - Phone:215-951-8122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003340103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist