Provider Demographics
NPI:1912212929
Name:WEISMAN, ELIZABETH R (LSW)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:R
Last Name:WEISMAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 BARCLAY ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1427
Mailing Address - Country:US
Mailing Address - Phone:267-257-8406
Mailing Address - Fax:
Practice Address - Street 1:1601 WALNUT ST
Practice Address - Street 2:SUITE 806
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-2944
Practice Address - Country:US
Practice Address - Phone:267-257-8406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW012508L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical