Provider Demographics
NPI:1285858258
Name:WEISMAN, SAMUEL K (PHD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:K
Last Name:WEISMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 W 75TH ST
Mailing Address - Street 2:SUITE 1-B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2060
Mailing Address - Country:US
Mailing Address - Phone:212-579-4244
Mailing Address - Fax:
Practice Address - Street 1:15 W 75TH ST
Practice Address - Street 2:SUITE 1-B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2060
Practice Address - Country:US
Practice Address - Phone:212-579-4244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013439103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical