Provider Demographics
NPI:1952497786
Name:WEISSMAN, GRACE FRAN (PH D)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:FRAN
Last Name:WEISSMAN
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7910 WOODMONT AVENUE
Mailing Address - Street 2:SUITE 1102
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-7020
Mailing Address - Country:US
Mailing Address - Phone:301-718-9772
Mailing Address - Fax:301-656-0544
Practice Address - Street 1:7910 WOODMONT AVENUE
Practice Address - Street 2:SUITE 1102
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-7020
Practice Address - Country:US
Practice Address - Phone:301-718-9772
Practice Address - Fax:301-656-0544
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01664103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH314 GL63OtherCAREFIRST BCBS
MDWE120489Medicare ID - Type Unspecified
WE120489Medicare UPIN