Provider Demographics
NPI:1982380895
Name:WEISS, HOLLY
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:WEISS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 E MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:NJ
Mailing Address - Zip Code:08049-1409
Mailing Address - Country:US
Mailing Address - Phone:856-602-4834
Mailing Address - Fax:
Practice Address - Street 1:212 E MADISON AVE
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:NJ
Practice Address - Zip Code:08049-1409
Practice Address - Country:US
Practice Address - Phone:856-602-4834
Practice Address - Fax:856-309-9716
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00737400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health