Provider Demographics
NPI:1578576187
Name:WEISS, JULIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:
Last Name:WEISS
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 1:111 CORNELL RD
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-2123
Mailing Address - Country:US
Mailing Address - Phone:610-667-2080
Mailing Address - Fax:215-442-1641
Practice Address - Street 1:111 CORNELL RD
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-2123
Practice Address - Country:US
Practice Address - Phone:610-667-2080
Practice Address - Fax:215-442-1641
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004874L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1499547103Medicaid
PA503712Medicare ID - Type UnspecifiedPSYCHOLOGY
PA1499547103Medicaid