Provider Demographics
NPI:1871673228
Name:WEITZMAN, MERRY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MERRY
Middle Name:
Last Name:WEITZMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MERRY
Other - Middle Name:
Other - Last Name:WEITZMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:240 E 2ND ST APT 4B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-8056
Mailing Address - Country:US
Mailing Address - Phone:191-769-2704
Mailing Address - Fax:
Practice Address - Street 1:99 UNIVERSITY PL FL 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4528
Practice Address - Country:US
Practice Address - Phone:191-769-2720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0722341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical