Provider Demographics
NPI:1073547816
Name:WEISNER, LYNNETTE BRANT (LCSW)
Entity Type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:BRANT
Last Name:WEISNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 REITZ BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9293
Mailing Address - Country:US
Mailing Address - Phone:570-524-0881
Mailing Address - Fax:570-524-9738
Practice Address - Street 1:11 REITZ BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9293
Practice Address - Country:US
Practice Address - Phone:570-524-0881
Practice Address - Fax:570-524-9738
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0126721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASO6816Medicare UPIN
PA0000794907Medicare ID - Type Unspecified