Provider Demographics
NPI:1477646792
Name:WEISS, JANICE L (LCSW)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:L
Last Name:WEISS
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 1:2409 W HEATHER RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-2719
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:930 OLD HARMONY RD
Practice Address - Street 2:SUITE C
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-4161
Practice Address - Country:US
Practice Address - Phone:302-737-9244
Practice Address - Fax:302-737-6244
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ100004321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE742OtherBLUE CROSS BLUE SHIELD
2264847OtherCIGNA
281192OtherMHN
186007OtherCOMP PSYCH