Provider Demographics
NPI:1972722627
Name:WEISSLITZ, JEFFREY ADAM (PSYD, LPC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ADAM
Last Name:WEISSLITZ
Suffix:
Gender:M
Credentials:PSYD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:22 GORDON AVE
Mailing Address - Street 2:PO BOX 6573
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-1033
Mailing Address - Country:US
Mailing Address - Phone:609-844-0452
Mailing Address - Fax:609-684-0518
Practice Address - Street 1:22 GORDON AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-1033
Practice Address - Country:US
Practice Address - Phone:609-844-0452
Practice Address - Fax:609-684-0518
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00302600101YP2500X
103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)