Healthcare Provider Details

I. General information

NPI: 1477901320
Provider Name (Legal Business Name): RACHELLE WEISS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 06/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5337 ORANGE DR
DAVIE FL
33314-3815
US

IV. Provider business mailing address

5537 ORANGE DRIVE
DAVIE FL
33314
US

V. Phone/Fax

Practice location:
  • Phone: 954-284-0025
  • Fax: 954-252-4037
Mailing address:
  • Phone: 954-284-0025
  • Fax: 954-252-4037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1706AD069401
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number1706AD069401
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: