Provider Demographics
NPI:1306196225
Name:WEISS, ERICA (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ERICA
Middle Name:
Last Name:WEISS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4360 DOUGLASTON PKWY
Mailing Address - Street 2:APT 122
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11363-1838
Mailing Address - Country:US
Mailing Address - Phone:646-256-8359
Mailing Address - Fax:
Practice Address - Street 1:4360 DOUGLASTON PKWY
Practice Address - Street 2:APT 122
Practice Address - City:DOUGLASTON
Practice Address - State:NY
Practice Address - Zip Code:11363-1838
Practice Address - Country:US
Practice Address - Phone:646-256-8359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021830235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist