Provider Demographics
NPI:1811249204
Name:WEISS, PETER B
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:B
Last Name:WEISS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8956 RESEARCH BLVD
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5902
Mailing Address - Country:US
Mailing Address - Phone:614-738-4762
Mailing Address - Fax:
Practice Address - Street 1:8956 RESEARCH BLVD
Practice Address - Street 2:BUILDING 2
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5902
Practice Address - Country:US
Practice Address - Phone:614-738-4762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX567821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical