Provider Demographics
NPI:1558461277
Name:WEIL, CONNIE G (LISW)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:G
Last Name:WEIL
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21625 CHAGRIN BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5364
Mailing Address - Country:US
Mailing Address - Phone:216-991-7766
Mailing Address - Fax:216-491-0155
Practice Address - Street 1:21625 CHAGRIN BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5364
Practice Address - Country:US
Practice Address - Phone:216-991-7766
Practice Address - Fax:216-491-0155
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00053561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical