Provider Demographics
NPI:1063409944
Name:WEIDEN, ELLEN (MSW)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:WEIDEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-6810
Mailing Address - Country:US
Mailing Address - Phone:413-443-1590
Mailing Address - Fax:413-443-1585
Practice Address - Street 1:261 SOUTH ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-6810
Practice Address - Country:US
Practice Address - Phone:413-443-1590
Practice Address - Fax:413-443-1585
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103244101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP01577Medicare ID - Type Unspecified