Provider Demographics
NPI:1700861986
Name:WEIST, JEFFREY (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:WEIST
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 OLD MILITARY RD #103
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311
Mailing Address - Country:US
Mailing Address - Phone:360-698-9258
Mailing Address - Fax:360-698-9296
Practice Address - Street 1:7500 OLD MILITARY RD #103
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311-3241
Practice Address - Country:US
Practice Address - Phone:360-698-9258
Practice Address - Fax:360-698-9296
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-12
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000066741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAB28369Medicare PIN