Provider Demographics
NPI:1841392578
Name:WEISS, JAMES A (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:A
Last Name:WEISS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8846 FORESTVIEW RD
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60203-1925
Mailing Address - Country:US
Mailing Address - Phone:847-329-9589
Mailing Address - Fax:847-329-9589
Practice Address - Street 1:1609 SHERMAN AVE
Practice Address - Street 2:SUITE 319
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3753
Practice Address - Country:US
Practice Address - Phone:847-329-9589
Practice Address - Fax:847-329-9589
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01634439OtherBLUECROSS BLUE SHIELD
364791Medicare ID - Type Unspecified