Provider Demographics
NPI:1932253879
Name:COHEN-WEISS, GALE MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:GALE
Middle Name:MARIE
Last Name:COHEN-WEISS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 HOLLY LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-4002
Mailing Address - Country:US
Mailing Address - Phone:904-396-0683
Mailing Address - Fax:
Practice Address - Street 1:VETERANS HEALTH SYSTEM, JACKSONVILLE OUTPATIENT CLINIC
Practice Address - Street 2:1833 BOULEVARD
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206
Practice Address - Country:US
Practice Address - Phone:904-232-2751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW35071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical