Provider Demographics
NPI:1225488968
Name:WEIL, KATHERINE (BA)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:WEIL
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1542 RANSOM ST
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-6810
Mailing Address - Country:US
Mailing Address - Phone:239-292-6192
Mailing Address - Fax:
Practice Address - Street 1:1542 RANSOM ST
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-6810
Practice Address - Country:US
Practice Address - Phone:239-292-6192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional