Provider Demographics
NPI:1942267257
Name:WEIDAW, CAROLE JEANNE (EDD)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:JEANNE
Last Name:WEIDAW
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 FORT COUCH RD
Mailing Address - Street 2:SUITE G-200
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15241-1030
Mailing Address - Country:US
Mailing Address - Phone:412-347-0170
Mailing Address - Fax:412-347-0174
Practice Address - Street 1:110 FORT COUCH RD
Practice Address - Street 2:SUITE G-200
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15241-1030
Practice Address - Country:US
Practice Address - Phone:412-347-0170
Practice Address - Fax:412-347-0174
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005916L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA699063OtherHIGHMARK BCBS
PA705999501Medicaid
S34942Medicare UPIN
PA699063Medicare ID - Type UnspecifiedHGS ADMINISTRATORS