Provider Demographics
NPI:1457556748
Name:WEISSMAN, STEVE ERIC (PHD)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:ERIC
Last Name:WEISSMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7508 BELL BLVD APT 1K
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-3402
Mailing Address - Country:US
Mailing Address - Phone:718-468-8646
Mailing Address - Fax:
Practice Address - Street 1:935 NORTHERN BLVD
Practice Address - Street 2:SUITE #102
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5309
Practice Address - Country:US
Practice Address - Phone:516-487-7116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017188103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical