Provider Demographics
NPI:1891899324
Name:WEISS, REGINA (MS, LMFT)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:
Last Name:WEISS
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:MS
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:WEISS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LMFT
Mailing Address - Street 1:PO BOX 1641
Mailing Address - Street 2:
Mailing Address - City:BIG BEAR LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92315-1641
Mailing Address - Country:US
Mailing Address - Phone:909-585-7228
Mailing Address - Fax:
Practice Address - Street 1:42718 MOONRIDGE ROAD
Practice Address - Street 2:
Practice Address - City:BIG BEAR LAKE
Practice Address - State:CA
Practice Address - Zip Code:92315
Practice Address - Country:US
Practice Address - Phone:909-585-7228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC19232106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist