Provider Demographics
NPI:1184782526
Name:WEILER, JOAN B (LCSW-R)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:B
Last Name:WEILER
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 783
Mailing Address - Street 2:
Mailing Address - City:CROSS RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10518-0783
Mailing Address - Country:US
Mailing Address - Phone:914-763-3244
Mailing Address - Fax:914-763-1126
Practice Address - Street 1:19 MARK MEAD RD
Practice Address - Street 2:
Practice Address - City:CROSS RIVER
Practice Address - State:NY
Practice Address - Zip Code:10518-1102
Practice Address - Country:US
Practice Address - Phone:914-763-3244
Practice Address - Fax:914-763-1126
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR013209-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN5035Medicare ID - Type Unspecified