Provider Demographics
NPI:1023888336
Name:WEISS, JAN L
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:L
Last Name:WEISS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 BASIL AVE
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21915-1106
Mailing Address - Country:US
Mailing Address - Phone:443-410-1048
Mailing Address - Fax:
Practice Address - Street 1:212 BLUE BALL AVE
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5222
Practice Address - Country:US
Practice Address - Phone:410-620-6077
Practice Address - Fax:410-620-6081
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)