Provider Demographics
NPI:1285864678
Name:WEIKERT, EDWARD W (LCSW)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:W
Last Name:WEIKERT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 CLAREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3409
Mailing Address - Country:US
Mailing Address - Phone:973-746-0800
Mailing Address - Fax:973-746-2822
Practice Address - Street 1:204 CLAREMONT AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3409
Practice Address - Country:US
Practice Address - Phone:973-746-0800
Practice Address - Fax:973-746-2822
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC003586001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ637481Medicare PIN