Provider Demographics
NPI:1578633103
Name:WEISS, JAN I (LMSW)
Entity Type:Individual
Prefix:MR
First Name:JAN
Middle Name:I
Last Name:WEISS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 HUNT FARM
Mailing Address - Street 2:
Mailing Address - City:WACCABUC
Mailing Address - State:NY
Mailing Address - Zip Code:10597
Mailing Address - Country:US
Mailing Address - Phone:914-763-2015
Mailing Address - Fax:914-763-2016
Practice Address - Street 1:1 GATEWAY PLAZA
Practice Address - Street 2:
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573
Practice Address - Country:US
Practice Address - Phone:914-937-2320
Practice Address - Fax:914-937-3183
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0219531104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker