Individual
MARTIN WEISHAAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCPAT, LCPC
Contact information
Practice address
3000 CHESTNUT AVE STE 202A, BALTIMORE, MD 21211-2727
(410) 801-9600
Mailing address
PO BOX 50031, BALTIMORE, MD 21211-4031
(410) 801-9600
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LC10198
MD
101YM0800X
Mental Health Counselor
ATC251
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
589044600
MEDICAID
MD
01
—
60054
AETNA
MD
01
—
833319030
CIGNA
MD
01
—
EJ14-0000
BLUE CROSS BLUE SHIELD
MD
Enumeration date
02/04/2019
Last updated
12/31/2020
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