Provider Demographics
NPI:1649316167
Name:WEINSTEIN, WALTER S (PHD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:S
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5341 W ATLANTIC AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-8167
Mailing Address - Country:US
Mailing Address - Phone:561-498-7542
Mailing Address - Fax:561-499-4378
Practice Address - Street 1:9305 NEPTUNES BASIN CT
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-5615
Practice Address - Country:US
Practice Address - Phone:561-482-4328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004136103TA0700X, 103TC0700X, 103TH0100X, 103T00000X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73504Medicare ID - Type Unspecified