Provider Demographics
NPI:1154496263
Name:WEISS, MARCY DATER (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARCY
Middle Name:DATER
Last Name:WEISS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MARCY
Other - Middle Name:DATER
Other - Last Name:WEISS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:5049 S LA SEDONA CIRCLE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484
Mailing Address - Country:US
Mailing Address - Phone:561-702-2228
Mailing Address - Fax:
Practice Address - Street 1:14000 N MILITARY TRAIL
Practice Address - Street 2:SUITE #112 DELRAY PROFESSIONAL CENTER
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484
Practice Address - Country:US
Practice Address - Phone:561-702-2228
Practice Address - Fax:561-637-2525
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW67321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical