Provider Demographics
NPI:1922117647
Name:WEIS, GERARDA THERESA (LCSW)
Entity Type:Individual
Prefix:
First Name:GERARDA
Middle Name:THERESA
Last Name:WEIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:GERARDA
Other - Middle Name:THERESA
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:10000 WATSON RD # 2L18
Mailing Address - Street 2:PERSONAL POTENTIALS INC
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-1854
Mailing Address - Country:US
Mailing Address - Phone:314-822-4727
Mailing Address - Fax:314-822-0531
Practice Address - Street 1:10000 WATSON RD # 2L18
Practice Address - Street 2:PERSONAL POTENTIALS INC
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-1854
Practice Address - Country:US
Practice Address - Phone:314-822-4727
Practice Address - Fax:314-822-0531
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0012801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
011869OtherA/B NETWORK PROVIDER
27033OtherCOMPSYCH NETWORK PROVIDER
100879OtherBCBS NETWORK PROVIDER