Individual provider Active NPI

Michele Greene Weisman, PH.D., LCSW

  • Clinical Social Worker
  • Englewood, NJ
National Provider Identifier
1457409567
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
44SC00163900 Issued in NJ
Practice address
58 Gentry Dr
Englewood, NJ 07631-5034
Phone
(201) 871-8572
Fax
(201) 227-0241
NPI assigned
Jan 8, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 44SC00163900 NJ Primary
Clinical Social Worker 1041C0700X 071434 NY

Addresses

Primary practice location

58 Gentry Dr
Englewood, NJ 07631-5034

Mailing address

58 Gentry Dr
Englewood, NJ 07631-5034
Phone (201) 871-8572

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050414000378 NJ Practitioner - Clinical Social Worker 5597702217 Practice locations: Ridgewood, NJ

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

75 N Maple Ave
Ridgewood, NJ 07450-3261
Phone (201) 913-5626

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
44SC00163900NJMDClinical Social Worker
071434NYMDClinical Social Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1457409567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "58 GENTRY DR",
            "city": "ENGLEWOOD",
            "state": "NJ",
            "postal_code": "076315034",
            "telephone_number": "201-871-8572",
            "fax_number": "201-227-0241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "58 GENTRY DR",
            "city": "ENGLEWOOD",
            "state": "NJ",
            "postal_code": "076315034",
            "telephone_number": "201-871-8572",
            "fax_number": "201-227-0241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEISMAN",
        "first_name": "MICHELE",
        "middle_name": "GREENE",
        "name_prefix": "Dr.",
        "credential": "PH.D., LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC00163900",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "071434",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Englewood, NJ

Sources for this page

Verify at the official NPI Registry.