Provider Demographics
NPI:1083871396
Name:WEISSENBERG, PATRICIA R (M ED)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:R
Last Name:WEISSENBERG
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3200
Mailing Address - Street 2:215 N CARLISLE AVENUE
Mailing Address - City:SOMERTON
Mailing Address - State:AZ
Mailing Address - Zip Code:85350
Mailing Address - Country:US
Mailing Address - Phone:928-341-6400
Mailing Address - Fax:928-341-6490
Practice Address - Street 1:215 N CARLISLE AVENUE
Practice Address - Street 2:
Practice Address - City:SOMERTON
Practice Address - State:AZ
Practice Address - Zip Code:85350-3200
Practice Address - Country:US
Practice Address - Phone:928-341-6041
Practice Address - Fax:928-341-6099
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2436087101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool