Provider Demographics
NPI:1326499658
Name:WEISS, REBECCA (LCSW, MSED)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
Last Name:WEISS
Suffix:
Gender:F
Credentials:LCSW, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-2822
Mailing Address - Country:US
Mailing Address - Phone:917-886-3869
Mailing Address - Fax:845-638-0548
Practice Address - Street 1:20 SQUADRON BLVD FL 1
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-5200
Practice Address - Country:US
Practice Address - Phone:917-886-3869
Practice Address - Fax:845-638-0548
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070492101YM0800X, 104100000X
NY0850541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker