Provider Demographics
NPI:1427222397
Name:VICTORIA L WEISS PSYD PC
Entity Type:Organization
Organization Name:VICTORIA L WEISS PSYD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD LP
Authorized Official - Phone:906-776-9000
Mailing Address - Street 1:PO BOX 901
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-0901
Mailing Address - Country:US
Mailing Address - Phone:906-776-9000
Mailing Address - Fax:906-776-9002
Practice Address - Street 1:427 S STEPHENSON AVENUE
Practice Address - Street 2:SUITE 212
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-3458
Practice Address - Country:US
Practice Address - Phone:906-776-9000
Practice Address - Fax:906-776-9002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007240103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty