Provider Demographics
NPI:1457409567
Name:WEISMAN, MICHELE GREENE (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:GREENE
Last Name:WEISMAN
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 GENTRY DR
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-5034
Mailing Address - Country:US
Mailing Address - Phone:201-871-8572
Mailing Address - Fax:201-227-0241
Practice Address - Street 1:58 GENTRY DR
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-5034
Practice Address - Country:US
Practice Address - Phone:201-871-8572
Practice Address - Fax:201-227-0241
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC001639001041C0700X
NY0714341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ637856Medicare ID - Type Unspecified