Provider Demographics
NPI:1558424895
Name:WEIERBACH, JANE L (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:L
Last Name:WEIERBACH
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 1:1630 MANHEIM PIKE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-3064
Mailing Address - Country:US
Mailing Address - Phone:717-560-6234
Mailing Address - Fax:717-560-6214
Practice Address - Street 1:1630 MANHEIM PIKE
Practice Address - Street 2:SUITE 4
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-3064
Practice Address - Country:US
Practice Address - Phone:717-560-6234
Practice Address - Fax:717-560-6214
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005450-L103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA592918Medicare ID - Type UnspecifiedLICENSED PSYCHOLOGIST