Provider Demographics
NPI:1285829739
Name:WEISS, JOAN MICHELLE (MFT)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:MICHELLE
Last Name:WEISS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3675 GREENHILL RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-2107
Mailing Address - Country:US
Mailing Address - Phone:626-510-9190
Mailing Address - Fax:626-316-7241
Practice Address - Street 1:3675 GREENHILL RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-2107
Practice Address - Country:US
Practice Address - Phone:626-510-9190
Practice Address - Fax:213-477-2189
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 11843106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist