Provider Demographics
NPI:1114458015
Name:WEISS, PEYTON-ANN (LCSW-R)
Entity Type:Individual
Prefix:
First Name:PEYTON-ANN
Middle Name:
Last Name:WEISS
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 KENSINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-8008
Mailing Address - Country:US
Mailing Address - Phone:631-335-6957
Mailing Address - Fax:
Practice Address - Street 1:25 KENSINGTON WAY
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-8008
Practice Address - Country:US
Practice Address - Phone:631-335-6957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR051695-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical