Provider Demographics
NPI:1922165992
Name:WEISSMAN-PARK, ROSELLE S (LCSW)
Entity Type:Individual
Prefix:
First Name:ROSELLE
Middle Name:S
Last Name:WEISSMAN-PARK
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 1:12B SMEDLEY LN STE 1
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-3206
Mailing Address - Country:US
Mailing Address - Phone:610-353-4377
Mailing Address - Fax:610-565-3625
Practice Address - Street 1:12B SMEDLEY LN STE 1
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-3206
Practice Address - Country:US
Practice Address - Phone:610-353-4377
Practice Address - Fax:610-565-3625
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
PACW0141731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical