Provider Demographics
NPI:1568503076
Name:WEITZ, SANDRA J SCHREIBER (MED)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:J SCHREIBER
Last Name:WEITZ
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:100 CUMMINGS CTR
Mailing Address - Street 2:SUITE 365-D
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6115
Mailing Address - Country:US
Mailing Address - Phone:978-210-7883
Mailing Address - Fax:978-233-7710
Practice Address - Street 1:100 CUMMINGS CTR
Practice Address - Street 2:SUITE 365-D
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6115
Practice Address - Country:US
Practice Address - Phone:978-210-7883
Practice Address - Fax:978-233-7710
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2014-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA458101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7001000LM2370OtherBLUE CROSS BLUE SHIELD
MA021560OtherMBHP