Provider Demographics
NPI:1508934910
Name:WEISS, RICHARD JEFFREY (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JEFFREY
Last Name:WEISS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 EL CAMINO REAL
Mailing Address - Street 2:#310
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3127
Mailing Address - Country:US
Mailing Address - Phone:650-697-8384
Mailing Address - Fax:650-697-3931
Practice Address - Street 1:1860 EL CAMINO REAL
Practice Address - Street 2:#310
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3127
Practice Address - Country:US
Practice Address - Phone:650-697-8384
Practice Address - Fax:650-697-3931
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8377103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL83770Medicare ID - Type Unspecified