Provider Demographics
NPI:1629195433
Name:WEISS, GERALD (LICSW)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:
Last Name:WEISS
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 N PLEASANT ST
Mailing Address - Street 2:#303
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-1738
Mailing Address - Country:US
Mailing Address - Phone:412-253-9809
Mailing Address - Fax:
Practice Address - Street 1:48 N PLEASANT ST
Practice Address - Street 2:#303
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-1738
Practice Address - Country:US
Practice Address - Phone:412-253-9809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA104671101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAWE-P20279Medicare PIN