Provider Demographics
NPI:1043760853
Name:WEISEL, ILANA (LCSW-C)
Entity type:Individual
Prefix:
First Name:ILANA
Middle Name:
Last Name:WEISEL
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5702 SARGENT RD
Mailing Address - Street 2:
Mailing Address - City:CHILLUM
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2321
Mailing Address - Country:US
Mailing Address - Phone:301-853-7370
Mailing Address - Fax:
Practice Address - Street 1:5702 SARGENT RD
Practice Address - Street 2:
Practice Address - City:CHILLUM
Practice Address - State:MD
Practice Address - Zip Code:20782-2321
Practice Address - Country:US
Practice Address - Phone:301-853-7370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD076191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical