Provider Demographics
NPI:1962541870
Name:WEISS, ROBERT L (LICSW)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:WEISS
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CIMINO RD
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-1937
Mailing Address - Country:US
Mailing Address - Phone:617-633-0764
Mailing Address - Fax:781-559-3252
Practice Address - Street 1:45 NEWBURY ST STE 208
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3146
Practice Address - Country:US
Practice Address - Phone:617-633-0764
Practice Address - Fax:617-531-2072
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10197551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP06210OtherBLUE CROSS BLUE SHIELD
MA405448OtherTUFTS
MA405448OtherTUFTS