Provider Demographics
NPI:1467840215
Name:WEISS, LIZA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LIZA
Middle Name:
Last Name:WEISS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 GULFSTREAM BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483
Mailing Address - Country:US
Mailing Address - Phone:561-455-2300
Mailing Address - Fax:
Practice Address - Street 1:500 GULFSTREAM BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-6144
Practice Address - Country:US
Practice Address - Phone:561-455-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-02
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7190103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical