Provider Demographics
NPI:1295984656
Name:WEITZ, RANDI LYNN (PSYD)
Entity type:Individual
Prefix:DR
First Name:RANDI
Middle Name:LYNN
Last Name:WEITZ
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 1:150 E SAMPLE RD
Mailing Address - Street 2:SUITE 330
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-3550
Mailing Address - Country:US
Mailing Address - Phone:954-784-0335
Mailing Address - Fax:954-784-0366
Practice Address - Street 1:50 E SAMPLE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-3552
Practice Address - Country:US
Practice Address - Phone:954-942-3991
Practice Address - Fax:954-941-4594
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7788103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist