Provider Demographics
NPI:1528572237
Name:CAYUGA COMPREHENSIVE PSYCHOLOGICAL SERVICES, PC
Entity Type:Organization
Organization Name:CAYUGA COMPREHENSIVE PSYCHOLOGICAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JED
Authorized Official - Middle Name:H
Authorized Official - Last Name:WEITZEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:607-273-6946
Mailing Address - Street 1:118 N TIOGA ST STE 302
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-4343
Mailing Address - Country:US
Mailing Address - Phone:607-273-6946
Mailing Address - Fax:607-256-1680
Practice Address - Street 1:118 N TIOGA ST STE 302
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4343
Practice Address - Country:US
Practice Address - Phone:607-273-6946
Practice Address - Fax:607-256-1680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-17
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8507103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1497804900OtherNPI