Provider Demographics
NPI:1467019901
Name:WEISS, KERRI (PHD)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:
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 1:1300 HIGHWAY 35
Mailing Address - Street 2:PLAZA III
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712
Mailing Address - Country:US
Mailing Address - Phone:732-845-1111
Mailing Address - Fax:
Practice Address - Street 1:1300 HIGHWAY 35
Practice Address - Street 2:PLAZA III
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712
Practice Address - Country:US
Practice Address - Phone:732-845-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4087103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4087OtherNJ STATE BOARD OF PSYCHOLOGICAL EXAMINERS