Provider Demographics
NPI:1558364554
Name:WEISMAN, MARCIA G (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:G
Last Name:WEISMAN
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 1:11 CROSS ST
Mailing Address - Street 2:
Mailing Address - City:SEA CLIFF
Mailing Address - State:NY
Mailing Address - Zip Code:11579-2122
Mailing Address - Country:US
Mailing Address - Phone:516-676-8516
Mailing Address - Fax:
Practice Address - Street 1:7136 110TH ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4852
Practice Address - Country:US
Practice Address - Phone:718-268-1634
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO131301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY83916Medicare ID - Type Unspecified