Provider Demographics
NPI:1922679281
Name:WEISSMAN, JANNAH (LSW)
Entity Type:Individual
Prefix:
First Name:JANNAH
Middle Name:
Last Name:WEISSMAN
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 1:321 HERBERTSVILLE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-1880
Mailing Address - Country:US
Mailing Address - Phone:732-451-4944
Mailing Address - Fax:732-612-1469
Practice Address - Street 1:321 HERBERTSVILLE RD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-1880
Practice Address - Country:US
Practice Address - Phone:732-451-4944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06633100104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker