Provider Demographics
NPI:1124400379
Name:WEISMAN, MIKKAH (LICSW)
Entity Type:Individual
Prefix:
First Name:MIKKAH
Middle Name:
Last Name:WEISMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:MIKKAH
Other - Middle Name:
Other - Last Name:BAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 SUMMER STREET UNIT 302
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038
Mailing Address - Country:US
Mailing Address - Phone:781-713-0797
Mailing Address - Fax:781-205-1241
Practice Address - Street 1:9 SUMMER STREET UNIT 302
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038
Practice Address - Country:US
Practice Address - Phone:781-713-0797
Practice Address - Fax:781-205-1241
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA99618201OtherNETWORK HEALTH
MA0000023532OtherBMC
MA1303287OtherMBHP
MA1004745OtherFALLON
MA042611055OtherTAX ID
MAM18633OtherBCBS
MA1004745OtherNHP