Provider Demographics
NPI:1467460634
Name:WEITZMAN, CASEY (MA)
Entity type:Individual
Prefix:MS
First Name:CASEY
Middle Name:
Last Name:WEITZMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 WESTWOOD BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6332
Mailing Address - Country:US
Mailing Address - Phone:310-441-0411
Mailing Address - Fax:310-441-0405
Practice Address - Street 1:2035 WESTWOOD BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6332
Practice Address - Country:US
Practice Address - Phone:310-441-0411
Practice Address - Fax:310-441-0405
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 28878106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist