Provider Demographics
NPI:1164733408
Name:BUCKS MONT PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:BUCKS MONT PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:215-355-8812
Mailing Address - Street 1:928 JAYMOR RD
Mailing Address - Street 2:SUITE A-120
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-3826
Mailing Address - Country:US
Mailing Address - Phone:215-355-8812
Mailing Address - Fax:215-322-0926
Practice Address - Street 1:928 JAYMOR RD
Practice Address - Street 2:SUITE A-120
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3826
Practice Address - Country:US
Practice Address - Phone:215-355-8812
Practice Address - Fax:215-322-0926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005712L103T00000X, 103TC0700X
PAMF000480106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty