Provider Demographics
NPI:1134280365
Name:WEISMAN, LAURENCE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:
Last Name:WEISMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 LINDEN ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-7900
Mailing Address - Country:US
Mailing Address - Phone:781-235-2662
Mailing Address - Fax:781-235-2682
Practice Address - Street 1:148 LINDEN ST
Practice Address - Street 2:SUITE 209
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-7900
Practice Address - Country:US
Practice Address - Phone:781-235-2662
Practice Address - Fax:781-235-2682
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4389103TA0400X, 103TA0700X, 103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW04265OtherBC-BS PROVIDER
MAW50600Medicare ID - Type Unspecified