Provider Demographics
NPI:1912979410
Name:WEISE, JEFFREY RALPH (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:RALPH
Last Name:WEISE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5869 FORBES AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-1601
Mailing Address - Country:US
Mailing Address - Phone:412-422-9160
Mailing Address - Fax:412-422-8180
Practice Address - Street 1:5869 FORBES AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-1601
Practice Address - Country:US
Practice Address - Phone:412-422-9160
Practice Address - Fax:412-422-8180
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008655L103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA646581OtherHIGHMARK BLUE SHIELD