Healthcare Provider Details

I. General information

NPI: 1821133356
Provider Name (Legal Business Name): JENNIFER CANDACE WEISSMAN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CANDACE WEISSMAN PSY.D.

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 BEACON ST SUITE 2 EAST
BROOKLINE MA
02446-5587
US

IV. Provider business mailing address

1101 BEACON ST SUITE 2 EAST
BROOKLINE MA
02446-5587
US

V. Phone/Fax

Practice location:
  • Phone: 617-417-9595
  • Fax:
Mailing address:
  • Phone: 617-417-9595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8685
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: