Provider Demographics
NPI:1326031683
Name:WEISS, CAROL G (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:G
Last Name:WEISS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 HERMOSA AVE
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-3781
Mailing Address - Country:US
Mailing Address - Phone:310-374-5191
Mailing Address - Fax:310-798-2197
Practice Address - Street 1:1001 HERMOSA AVE
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-3781
Practice Address - Country:US
Practice Address - Phone:310-374-5191
Practice Address - Fax:310-798-2197
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15440103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP15440Medicare ID - Type Unspecified