Provider Demographics
NPI:1982672556
Name:WEILAND, KARL (LICSW)
Entity Type:Individual
Prefix:MR
First Name:KARL
Middle Name:
Last Name:WEILAND
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 FLETCHER AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-3721
Mailing Address - Country:US
Mailing Address - Phone:617-666-4321
Mailing Address - Fax:617-666-4678
Practice Address - Street 1:1234 BROADWAY
Practice Address - Street 2:SUITE 6
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-1703
Practice Address - Country:US
Practice Address - Phone:617-666-4321
Practice Address - Fax:617-666-4678
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10162451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO4682Medicare ID - Type Unspecified