Provider Demographics
NPI:1467090654
Name:WEITZ, SYDNEY M (LCSW)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:M
Last Name:WEITZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2285 SPRUCE GOOSE ST # A406
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-2631
Mailing Address - Country:US
Mailing Address - Phone:406-839-0740
Mailing Address - Fax:
Practice Address - Street 1:1408 S JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1231
Practice Address - Country:US
Practice Address - Phone:702-202-0099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8671-C101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health