Provider Demographics
NPI:1770555849
Name:WEISS, JOANNE G (MSW LCSW MA MDIV DAR)
Entity type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:G
Last Name:WEISS
Suffix:
Gender:F
Credentials:MSW LCSW MA MDIV DAR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 162
Mailing Address - Street 2:
Mailing Address - City:LAKE ARIEL
Mailing Address - State:PA
Mailing Address - Zip Code:18436-0162
Mailing Address - Country:US
Mailing Address - Phone:570-352-4419
Mailing Address - Fax:570-698-4013
Practice Address - Street 1:301 W GROVE ST
Practice Address - Street 2:PROFESSIONAL PLAZA
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411
Practice Address - Country:US
Practice Address - Phone:570-352-4419
Practice Address - Fax:570-698-4013
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACSW006812L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
2099635OtherCIGNA
PA000711767OtherHMBS
PA11605420OtherCAQH
PA802133Other1ST PRIORITY HEALTH
PA136787Medicare PIN