Provider Demographics
NPI:1841261781
Name:WEISSERT, GAIL JOANN (MSW LCSW)
Entity type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:JOANN
Last Name:WEISSERT
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23627 WILLOW POND RD
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629-2104
Mailing Address - Country:US
Mailing Address - Phone:410-479-0434
Mailing Address - Fax:410-479-2723
Practice Address - Street 1:23627 WILLOW POND RD
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:MD
Practice Address - Zip Code:21629-2104
Practice Address - Country:US
Practice Address - Phone:410-479-0434
Practice Address - Fax:410-479-2723
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2023-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02976104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD303241800Medicaid