Provider Demographics
NPI:1821133356
Name:WEISSMAN, JENNIFER CANDACE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:CANDACE
Last Name:WEISSMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:CANDACE
Other - Middle Name:
Other - Last Name:WEISSMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:1101 BEACON ST
Mailing Address - Street 2:SUITE 2 EAST
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5587
Mailing Address - Country:US
Mailing Address - Phone:617-417-9595
Mailing Address - Fax:
Practice Address - Street 1:1101 BEACON ST
Practice Address - Street 2:SUITE 2 EAST
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5587
Practice Address - Country:US
Practice Address - Phone:617-417-9595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8685103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical