Provider Demographics
NPI:1457335291
Name:WEISZ, STEPHANIE LYNN (MSW LLCSW)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:LYNN
Last Name:WEISZ
Suffix:
Gender:F
Credentials:MSW LLCSW
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:WEISZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LLCSW
Mailing Address - Street 1:78 ELMWOOD ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-1325
Mailing Address - Country:US
Mailing Address - Phone:508-699-4952
Mailing Address - Fax:
Practice Address - Street 1:78 ELMWOOD ST
Practice Address - Street 2:
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-1325
Practice Address - Country:US
Practice Address - Phone:508-699-4952
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1015834104100000X
RIISW00135104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
018411OtherOPTIONS
152774OtherMHN VENDER 1002739
6212883OtherUBH
008047OtherHPHC
119207OtherVO
332324OtherHMD BLUE NE
RI72838OtherRI BC BS
716886OtherTUFTO
MAP05040OtherMA BC BS
152774OtherMHN VENDER 1002739