Provider Demographics
NPI:1275306912
Name:WEIL, DANIEL J (LMFT)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:J
Last Name:WEIL
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2493
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95473-2493
Mailing Address - Country:US
Mailing Address - Phone:415-279-4910
Mailing Address - Fax:
Practice Address - Street 1:3271 JUNIPER AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-7761
Practice Address - Country:US
Practice Address - Phone:415-279-4910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110783106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist