Provider Demographics
NPI:1346797032
Name:WEISE, DEON M (LMSW)
Entity Type:Individual
Prefix:MR
First Name:DEON
Middle Name:M
Last Name:WEISE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 LENOX RD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-2486
Mailing Address - Country:US
Mailing Address - Phone:718-715-0511
Mailing Address - Fax:718-715-0511
Practice Address - Street 1:180 LENOX RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-2486
Practice Address - Country:US
Practice Address - Phone:718-715-0511
Practice Address - Fax:718-715-0511
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001839104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker