Healthcare Provider Details

I. General information

NPI: 1497972855
Provider Name (Legal Business Name): DENNIS WEISE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 05/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 DATURA ST STE 414
WEST PALM BEACH FL
33401-5632
US

IV. Provider business mailing address

224 DATURA ST STE 414
WEST PALM BEACH FL
33401-5632
US

V. Phone/Fax

Practice location:
  • Phone: 561-707-6311
  • Fax:
Mailing address:
  • Phone: 561-707-6311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY 3680
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License NumberPY3680
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY3680
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: