Healthcare Provider Details

I. General information

NPI: 1285790279
Provider Name (Legal Business Name): DEBORAH WEINHAUS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 NEEDHAM ST
NEWTON MA
02464-1596
US

IV. Provider business mailing address

188 NEEDHAM ST
NEWTON MA
02464-1596
US

V. Phone/Fax

Practice location:
  • Phone: 508-306-1655
  • Fax:
Mailing address:
  • Phone: 508-306-1655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number8104
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number8104
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number8104
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: