Provider Demographics
NPI:1629143664
Name:WEISS, REBECCA ANNE (BA)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ANNE
Last Name:WEISS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:ANNE
Other - Last Name:HERMSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:1100 SPORTFISHER DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-2550
Mailing Address - Country:US
Mailing Address - Phone:760-439-6702
Mailing Address - Fax:760-439-4779
Practice Address - Street 1:1100 SPORTFISHER DR
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-2550
Practice Address - Country:US
Practice Address - Phone:760-439-6702
Practice Address - Fax:760-439-4779
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health