Provider Demographics
NPI:1922292788
Name:WEISS, DEBORAH A (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
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 1:225 W BRECKINRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203-2219
Mailing Address - Country:US
Mailing Address - Phone:502-637-4361
Mailing Address - Fax:502-587-7145
Practice Address - Street 1:225 W BRECKINRIDGE ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2219
Practice Address - Country:US
Practice Address - Phone:502-637-4361
Practice Address - Fax:502-587-7145
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5216104100000X
KY34981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker