Provider Demographics
NPI:1932304425
Name:WEISS, LAURIE R (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:R
Last Name:WEISS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 BOREL PL
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-3503
Mailing Address - Country:US
Mailing Address - Phone:650-458-9492
Mailing Address - Fax:
Practice Address - Street 1:1611 BOREL PL
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-3503
Practice Address - Country:US
Practice Address - Phone:650-458-9492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15143103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral