Provider Demographics
NPI:1144401977
Name:WEISKO, ALICE DEBORAH (PSY D)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:DEBORAH
Last Name:WEISKO
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5432
Mailing Address - Country:US
Mailing Address - Phone:410-937-8029
Mailing Address - Fax:410-550-1610
Practice Address - Street 1:1107 KENILWORTH DR STE 320
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2135
Practice Address - Country:US
Practice Address - Phone:410-937-8029
Practice Address - Fax:410-550-1610
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3333103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD020198OtherEMPLOYER'S HEALTH PROGRAM