Provider Demographics
NPI:1497428825
Name:WEISBEIN, EDWARD BENJAMIN (JD, LMHC, LPC, MCAP)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:BENJAMIN
Last Name:WEISBEIN
Suffix:
Gender:M
Credentials:JD, LMHC, LPC, MCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4799 VIA PALM LKS APT 1605
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-2730
Mailing Address - Country:US
Mailing Address - Phone:215-901-0176
Mailing Address - Fax:
Practice Address - Street 1:4799 VIA PALM LKS APT 1605
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-2730
Practice Address - Country:US
Practice Address - Phone:215-901-0176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012493101YP2500X
FLMH19685101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional