Provider Demographics
NPI:1801181821
Name:WEISSMAN, DUSTIN RAYMOND
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:RAYMOND
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:PO BOX 1968
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91376-1968
Mailing Address - Country:US
Mailing Address - Phone:805-601-7098
Mailing Address - Fax:
Practice Address - Street 1:5016 PARKWAY CALABASAS
Practice Address - Street 2:STE 215
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-3927
Practice Address - Country:US
Practice Address - Phone:805-601-7098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA174400000XOtherOTHER