Provider Demographics
NPI:1174565105
Name:WEISS, STEPHEN JEFFREY (MSW)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:JEFFREY
Last Name:WEISS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14832 N EL FRIO ST
Mailing Address - Street 2:
Mailing Address - City:EL MIRAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85335-6952
Mailing Address - Country:US
Mailing Address - Phone:623-242-6006
Mailing Address - Fax:
Practice Address - Street 1:3450 N 3RD ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2331
Practice Address - Country:US
Practice Address - Phone:602-265-8338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10154051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical