Provider Demographics
NPI:1730544123
Name:WEISS, NANCY L (LCSW)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:WEISS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6215 DEL VALLE DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5305
Mailing Address - Country:US
Mailing Address - Phone:323-934-5484
Mailing Address - Fax:323-297-2972
Practice Address - Street 1:6215 DEL VALLE DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5305
Practice Address - Country:US
Practice Address - Phone:323-934-5484
Practice Address - Fax:323-297-2972
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS88871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical