Provider Demographics
NPI:1346296092
Name:WEISS, GERARD H (LCSW)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:H
Last Name:WEISS
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 1:87 E MAIDEN ST
Mailing Address - Street 2:SUITE31
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-4964
Mailing Address - Country:US
Mailing Address - Phone:724-225-3444
Mailing Address - Fax:724-222-2189
Practice Address - Street 1:87 E MAIDEN ST
Practice Address - Street 2:SUITE31
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-4964
Practice Address - Country:US
Practice Address - Phone:724-225-3444
Practice Address - Fax:724-222-2189
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0137251041C0700X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA636648Medicare ID - Type Unspecified