Provider Demographics
NPI:1720357460
Name:WEITZMAN, TAMMY SOPHIA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:SOPHIA
Last Name:WEITZMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:SOPHIA
Other - Last Name:WEITZMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:377 COMMONWEALTH AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-1800
Mailing Address - Country:US
Mailing Address - Phone:857-294-6166
Mailing Address - Fax:
Practice Address - Street 1:377 COMMONWEALTH AVE STE 4
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-1800
Practice Address - Country:US
Practice Address - Phone:857-294-6166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1154811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical