Provider Demographics
NPI:1376828822
Name:WEISS, SANDRA COHN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:COHN
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 1:31423 COAST HIGHWAY #29
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-6994
Mailing Address - Country:US
Mailing Address - Phone:949-499-5293
Mailing Address - Fax:
Practice Address - Street 1:31423 COAST HWY APT 29
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-6994
Practice Address - Country:US
Practice Address - Phone:949-499-5293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT6604101YM0800X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No282N00000XHospitalsGeneral Acute Care Hospital