Provider Demographics
NPI:1265594436
Name:WEISS, NICOLA (PHD)
Entity type:Individual
Prefix:DR
First Name:NICOLA
Middle Name:
Last Name:WEISS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 GLOUCESTER ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4706
Mailing Address - Country:US
Mailing Address - Phone:201-320-7174
Mailing Address - Fax:800-724-7270
Practice Address - Street 1:416 GLOUCESTER ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4706
Practice Address - Country:US
Practice Address - Phone:201-320-7174
Practice Address - Fax:800-724-7270
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3844103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ087130TQDMedicare ID - Type Unspecified
NJY25429Medicare UPIN