Provider Demographics
NPI:1114011038
Name:WEISBERG-SAMUELS, JANET S (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:S
Last Name:WEISBERG-SAMUELS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 EAST 89TH STREET
Mailing Address - Street 2:STE 1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3231
Mailing Address - Country:US
Mailing Address - Phone:212-410-4391
Mailing Address - Fax:212-410-4391
Practice Address - Street 1:160 EAST 89TH STREET
Practice Address - Street 2:STE 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-3231
Practice Address - Country:US
Practice Address - Phone:212-410-4391
Practice Address - Fax:212-410-4391
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8339-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV67331Medicare ID - Type Unspecified