Provider Demographics
NPI:1902001852
Name:WEISS, BONNIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:
Last Name:WEISS
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 1:1240 SUSSEX TPKE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-2944
Mailing Address - Country:US
Mailing Address - Phone:973-285-0361
Mailing Address - Fax:
Practice Address - Street 1:1240 SUSSEX TPKE
Practice Address - Street 2:SUITE 4
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-2944
Practice Address - Country:US
Practice Address - Phone:973-285-0361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC003972001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical