Provider Demographics
NPI:1851514616
Name:WEISS, BURTON A (PHD)
Entity Type:Individual
Prefix:DR
First Name:BURTON
Middle Name:A
Last Name:WEISS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-2334
Mailing Address - Country:US
Mailing Address - Phone:856-232-1667
Mailing Address - Fax:856-374-2877
Practice Address - Street 1:LIBERAL ARTS DIV., UNIV. OF THE ARTS
Practice Address - Street 2:320 SOUTH BROAD STREET
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102
Practice Address - Country:US
Practice Address - Phone:215-717-6260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS000308L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist