Provider Demographics
NPI:1497820781
Name:WEISS, DAVID JAY (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JAY
Last Name:WEISS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:89 STANIFORD ST
Mailing Address - Street 2:SUITE #7
Mailing Address - City:AUBURNDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02466-1128
Mailing Address - Country:US
Mailing Address - Phone:617-821-7393
Mailing Address - Fax:617-630-1849
Practice Address - Street 1:89 STANIFORD ST
Practice Address - Street 2:SUITE #7
Practice Address - City:AUBURNDALE
Practice Address - State:MA
Practice Address - Zip Code:02466-1128
Practice Address - Country:US
Practice Address - Phone:617-821-7393
Practice Address - Fax:617-630-1849
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1848103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW01959Medicare ID - Type Unspecified