Provider Demographics
NPI:1114950011
Name:WEISBERG, JANET E (LCSW-R)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:E
Last Name:WEISBERG
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 BLUEBERRY LN
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4631
Mailing Address - Country:US
Mailing Address - Phone:516-662-5361
Mailing Address - Fax:631-654-1560
Practice Address - Street 1:4 PHYLLIS DR
Practice Address - Street 2:SUITE A-1
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-2900
Practice Address - Country:US
Practice Address - Phone:631-654-1560
Practice Address - Fax:631-654-1560
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR069868-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02608991Medicaid
NY02608991Medicaid