Provider Demographics
NPI:1518271865
Name:WEISS, SARA L (ED,D)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:L
Last Name:WEISS
Suffix:
Gender:F
Credentials:ED,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 RICHMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5906
Mailing Address - Country:US
Mailing Address - Phone:718-494-9397
Mailing Address - Fax:718-761-1000
Practice Address - Street 1:251 RICHMOND HILL RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-5906
Practice Address - Country:US
Practice Address - Phone:718-494-9397
Practice Address - Fax:718-761-1000
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006509103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic