Provider Demographics
NPI:1730606682
Name:WEITZMAN, LAURIE (LCSW-C)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:WEITZMAN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:BERSON
Other - Last Name:WEITZMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:121 LAZY HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2764
Mailing Address - Country:US
Mailing Address - Phone:240-444-7220
Mailing Address - Fax:
Practice Address - Street 1:12301 ACADEMY WAY STE 270
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2000
Practice Address - Country:US
Practice Address - Phone:301-984-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20834104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker