Provider Demographics
NPI:1215115431
Name:WEISSMAN, ERIC NILES (PSYD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:NILES
Last Name:WEISSMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 582
Mailing Address - Street 2:18 SCOTCHTOWN AVE
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924
Mailing Address - Country:US
Mailing Address - Phone:845-800-4172
Mailing Address - Fax:845-294-1126
Practice Address - Street 1:18 SCOTCHTOWN AVE
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924
Practice Address - Country:US
Practice Address - Phone:845-800-4172
Practice Address - Fax:845-294-1126
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103TS0200X
NY0161291103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy