Provider Demographics
NPI:1508151713
Name:WEISBERG, MICHAEL JACOB (LMHC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JACOB
Last Name:WEISBERG
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5580 NW 61ST ST APT 627
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-2522
Mailing Address - Country:US
Mailing Address - Phone:954-295-3965
Mailing Address - Fax:
Practice Address - Street 1:5580 NW 61ST ST APT 627
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-2522
Practice Address - Country:US
Practice Address - Phone:954-295-3965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2012-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9318101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health