Provider Demographics
NPI:1225408941
Name:WEISS, PETER (PHD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:WEISS
Suffix:
Gender:M
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:PO BOX 872708
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98687-2708
Mailing Address - Country:US
Mailing Address - Phone:360-606-5453
Mailing Address - Fax:
Practice Address - Street 1:237 NE CHKALOV DR STE 118
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5054
Practice Address - Country:US
Practice Address - Phone:360-606-5453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60427281103TC0700X
NY015520103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical