MEDICARE: DR. CAROL ANN WEISSMAN PHD

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	103T00000X	Psychologist	0092731	NY
2	103T00000X	Psychologist	PY5650	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	U0953	OTHER	FL	MEDICARE PTAN

General Provider Information

NPI Number	:	1669510806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROL ANN WEISSMAN PHD

Provider Business Mailing Address
First Line	:	5 SCHENCK AVE
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-3600
Country	:	US
Telephone Number	:	516-268-0681
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 SCHENCK AVE
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-3600
Country	:	US
Telephone Number	:	516-268-0681
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	12/15/2017

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Directions to “ DR. CAROL ANN WEISSMAN PHD” Practice Location

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