Healthcare Provider Details

I. General information

NPI: 1225075492
Provider Name (Legal Business Name): NORMAN E WEITZBERG PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 HANOVER ST SUITE #204
FALL RIVER MA
02720-5246
US

IV. Provider business mailing address

235 HANOVER ST SUITE #204
FALL RIVER MA
02720-5246
US

V. Phone/Fax

Practice location:
  • Phone: 508-679-8591
  • Fax: 508-679-8630
Mailing address:
  • Phone: 508-679-8591
  • Fax: 508-679-8630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2291
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: