Provider Demographics
NPI:1104061944
Name:KAREN WEISBARD, PSYD, P.S. INC
Entity type:Organization
Organization Name:KAREN WEISBARD, PSYD, P.S. INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:HOPE
Authorized Official - Last Name:WEISBARD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:206-525-6783
Mailing Address - Street 1:5122 25TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105
Mailing Address - Country:US
Mailing Address - Phone:206-525-6783
Mailing Address - Fax:
Practice Address - Street 1:5122 25TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105
Practice Address - Country:US
Practice Address - Phone:206-525-6783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAREN WEISBARD, PSY.D., P.S.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-09
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA01578103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty