Provider Demographics
NPI:1821481599
Name:WEISS, LEAH SUE (MFTI)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:SUE
Last Name:WEISS
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6233 SOQUEL DR STE C
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-3184
Mailing Address - Country:US
Mailing Address - Phone:831-216-8696
Mailing Address - Fax:
Practice Address - Street 1:6233 SOQUEL DR STE C
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-3184
Practice Address - Country:US
Practice Address - Phone:831-216-8696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF84903101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health