Provider Demographics
NPI:1689834616
Name:WEISS, SHARON A (LCSW-C)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:A
Last Name:WEISS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 BENSTON PL
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-1415
Mailing Address - Country:US
Mailing Address - Phone:410-433-9296
Mailing Address - Fax:
Practice Address - Street 1:2324 W JOPPA RD STE 220
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4618
Practice Address - Country:US
Practice Address - Phone:410-433-9296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD054511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD985400200Medicaid