Provider Demographics
NPI:1891362869
Name:WEISER, REBECCA ANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANNE
Last Name:WEISER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 EASTERN PKWY # 6C1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-5940
Mailing Address - Country:US
Mailing Address - Phone:914-646-6354
Mailing Address - Fax:
Practice Address - Street 1:1967 WEHRLE DR STE 1086
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14221-8452
Practice Address - Country:US
Practice Address - Phone:415-403-2156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0914511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY091451OtherNEW YORK STATE OFFICE OF THE PROFESSIONS