Provider Demographics
NPI:1942264338
Name:WEISS, TOBIAS C (PSYD)
Entity Type:Individual
Prefix:
First Name:TOBIAS
Middle Name:C
Last Name:WEISS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 FARRELL DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41011-3717
Mailing Address - Country:US
Mailing Address - Phone:859-331-3292
Mailing Address - Fax:589-578-2864
Practice Address - Street 1:718 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:KY
Practice Address - Zip Code:41071-1837
Practice Address - Country:US
Practice Address - Phone:859-491-6510
Practice Address - Fax:859-491-6589
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1393103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY184607OtherMEDICARE PIN NUMBER GROUP