PE GERARD WEIDEMAN, MS, MSW, LPCC, LADAC - NPI NUMBER 1639285638

Summary

Provider Name: PE GERARD WEIDEMAN, MS, MSW, LPCC, LADAC

NPI Number: 1639285638

Clasification: Counselor (101YA0400X)

Specialization: Addiction (Substance Use Disorder)

Address:
501 W PINE ST
DEMING, NM
ZIP 88030

Phone Number: (505) 541-1695



Detailed Information

Pe Gerard Weideman, MS, MSW, LPCC, LADAC is an addiction counselor in Deming, NM. The assigned NPI number for this provider is 1639285638 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business address is:

501 W PINE ST
DEMING, NM
ZIP 88030-530
Phone: (505) 541-1695
Fax: (505) 647-3033

The enumeration date for this NPI number is 8/22/2006 and was last updated on 4/18/2009.

Map - Location of Practice

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 101YA0400X Counselor Addiction (Substance Use Disorder) 005438 NM No
2 101YM0800X Counselor Mental Health 005849 NM Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 A9813 MEDICAID NM

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1639285638 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 1 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Provider Last Name Legal Name WEIDEMAN The last name of the provider. If the provider is an individual, this is the legal name.
4 Provider First Name PE GERARD The first name of the provider, if the provider is an individual.
5 Provider Credential Text MS, MSW, LPCC, LADAC The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
6 Provider First Line Business Practice Location Address 501 W PINE ST The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
7 Provider Business Practice Location Address City Name DEMING The city name in the location address of the provider being identified.
8 Provider Business Practice Location Address State Name NM The State code in the location of the provider being identified.
9 Provider Business Practice Location Address Postal Code 880303530 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
10 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
11 Provider Business Practice Location Address Telephone Number 5055411695 The telephone number associated with the location address of the provider being identified.
12 Provider Business Practice Location Address Fax Number 5056473033 The fax number associated with the location address of the provider being identified.
13 Provider Enumeration Date 8/22/2006 The date the provider was assigned a unique identifier (assigned an NPI).
14 Last Update Date 4/18/2009 The date that a record was last updated or changed.
15 Provider Gender Code M The code designating the provider’s gender if the provider is a person.
16 Healthcare Provider Taxonomy Code 1 101YA0400X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
17 Provider License Number 1 005438 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
18 Provider License Number State Code 1 NM The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
19 Healthcare Provider Primary Taxonomy Switch 1 N
20 Healthcare Provider Taxonomy Code 2 101YM0800X
21 Provider License Number 2 005849 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
22 Provider License Number State Code 2 NM The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
23 Healthcare Provider Primary Taxonomy Switch 2 Y
24 Other Provider Identifier 1 A9813 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
25 Other Provider Identifier Type Code 1 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
26 Other Provider Identifier State 1 NM
27 Is Sole Proprietor N Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No

Similar Providers Nearby

NPI Provider Name NPI Type Taxonomy
1013100668 MS. KATHRYN DIANNE STEPHENS, LPCC Individual Counselor (Professional)
1184950966 MS. ELIZABETH A BURR, LPCC Individual Counselor
1124258652 MRS. SKYE TRINITY NORTON, M.A. Individual Counselor (Mental Health)
1215981386 MRS. YOLANDA ATENCIO, LISW Individual Counselor (Mental Health)
1083724793 JULIANNA GREER, LPCC / LMFT Individual Counselor
1972685642 ANN MARIE UNRAST, LPCC Individual Counselor (Professional)
1891926762 MR. ALFRED C CHAVEZ, B.S. Individual Counselor (Addiction (Substance Use Disorder))
1427381219 WALDO WINBORN, LPCC Individual Counselor (Mental Health)


Download NPI Record

Download this NPI record in Text format: Export

Download this NPI record in Excel (CSV) format: Export

Download this NPI record in XML format: Export




This page was last updated on: 4/19/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.