Provider Demographics
NPI:1194788430
Name:WEISS, PAMELA GALE (PHD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:GALE
Last Name:WEISS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4609 WINTHROP ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-3718
Mailing Address - Country:US
Mailing Address - Phone:412-683-9144
Mailing Address - Fax:412-682-8196
Practice Address - Street 1:4609 WINTHROP ST
Practice Address - Street 2:SUITE 202
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-3718
Practice Address - Country:US
Practice Address - Phone:412-683-9144
Practice Address - Fax:412-682-8196
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002562L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA126353Medicare ID - Type UnspecifiedBC/BS AND MEDICARE NO.