Provider Demographics
NPI:1790267300
Name:WEISSMAN, HARVEY
Entity Type:Individual
Prefix:
First Name:HARVEY
Middle Name:
Last Name:WEISSMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W 145TH ST APT 4Q
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-3145
Mailing Address - Country:US
Mailing Address - Phone:917-406-7254
Mailing Address - Fax:
Practice Address - Street 1:6 E 39TH ST STE 800
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0037
Practice Address - Country:US
Practice Address - Phone:917-406-7254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086420-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical