Provider Demographics
NPI:1760584148
Name:WEYAND, PATRICIA M (MS LCPC)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:M
Last Name:WEYAND
Suffix:
Gender:F
Credentials:MS LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 STORER ST
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-6832
Mailing Address - Country:US
Mailing Address - Phone:207-985-7140
Mailing Address - Fax:
Practice Address - Street 1:836 MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-2861
Practice Address - Country:US
Practice Address - Phone:207-856-0090
Practice Address - Fax:207-856-0090
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC1669101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME047762OtherANTHEM BC/BS