MEDICARE: DR. WEISSMAN PSYCHOLOGY, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1023765120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. WEISSMAN PSYCHOLOGY, INC

Provider Business Mailing Address
First Line	:	5706 CORSA AVE STE 200I
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91362-4057
Country	:	US
Telephone Number	:	818-336-1041
Fax Number	:

Provider Business Practice Location Address
First Line	:	5706 CORSA AVE STE 200I
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91362-4057
Country	:	US
Telephone Number	:	818-336-1041
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. ELLEN WEISSMAN
Credential	:	PSYD
Telephone Number	:	818-336-1041

Provider Enumeration Date	:	03/08/2022
Last Update Date	:	03/08/2022

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