Provider Demographics
NPI:1497878813
Name:WEISHAAR, MARJORIE ELLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:ELLEN
Last Name:WEISHAAR
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 1:121 EMELINE ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4204
Mailing Address - Country:US
Mailing Address - Phone:401-861-1180
Mailing Address - Fax:401-861-1180
Practice Address - Street 1:295 ANGELL ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2119
Practice Address - Country:US
Practice Address - Phone:401-861-3232
Practice Address - Fax:401-861-1180
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS 293103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist