Provider Demographics
NPI:1386799468
Name:WEISBURG, MARC J (LPMHC)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:J
Last Name:WEISBURG
Suffix:
Gender:M
Credentials:LPMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 SILVERSIDE RD STE 37
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809-1388
Mailing Address - Country:US
Mailing Address - Phone:302-409-0750
Mailing Address - Fax:
Practice Address - Street 1:501 SILVERSIDE RD STE 37
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19809-1388
Practice Address - Country:US
Practice Address - Phone:302-409-0750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000778101YM0800X, 101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000036908Medicaid