Provider Demographics
NPI:1962723072
Name:WEIDMAN, KARLA (MS, LCAT, CASAC)
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:WEIDMAN
Suffix:
Gender:F
Credentials:MS, LCAT, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5247 SWADLING RD
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:NY
Mailing Address - Zip Code:14519-9126
Mailing Address - Country:US
Mailing Address - Phone:585-509-0333
Mailing Address - Fax:
Practice Address - Street 1:6301 FURNACE RD
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:NY
Practice Address - Zip Code:14519-9760
Practice Address - Country:US
Practice Address - Phone:585-509-0333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NY1800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)