Provider Demographics
NPI:1992300057
Name:WEISS, AMY KATHERINE (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:KATHERINE
Last Name:WEISS
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S SHADOWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-3839
Mailing Address - Country:US
Mailing Address - Phone:304-888-7513
Mailing Address - Fax:
Practice Address - Street 1:1617 N WALKER ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2624
Practice Address - Country:US
Practice Address - Phone:681-282-5130
Practice Address - Fax:681-282-5130
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009446691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical