Healthcare Provider Details

I. General information

NPI: 1649316167
Provider Name (Legal Business Name): WALTER S. WEINSTEIN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9305 NEPTUNES BASIN CT
BOCA RATON FL
33434-5615
US

IV. Provider business mailing address

5341 W ATLANTIC AVE SUITE 304
DELRAY BEACH FL
33484-8167
US

V. Phone/Fax

Practice location:
  • Phone: 561-482-4328
  • Fax:
Mailing address:
  • Phone: 561-498-7542
  • Fax: 561-499-4378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPY0004136
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY0004136
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPY0004136
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY0004136
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberPY0004136
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: