Provider Demographics
NPI:1831819135
Name:WEIST, JAMIE BETH (LSW)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:BETH
Last Name:WEIST
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 BARING ST APT 3F
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5801
Mailing Address - Country:US
Mailing Address - Phone:610-463-6109
Mailing Address - Fax:
Practice Address - Street 1:1501 LOWER STATE RD STE 200
Practice Address - Street 2:
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-1216
Practice Address - Country:US
Practice Address - Phone:215-343-8987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW139649104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker