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General NPI Number Information
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NPI Number | 1528572237
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Entity Type | Organization
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Legal Business Name | CAYUGA COMPREHENSIVE PSYCHOLOGICAL SERVICES, PC
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Dates
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Enumeration Date | 11/17/2017
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Last Update Date | 11/17/2017
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Provider Practice Location Address
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Address Line | 118 N TIOGA ST STE 302
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City | ITHACA
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State | NY
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Zip | 14850-4343
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Country | US
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Telephone | 607-273-6946
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Fax | 607-256-1680
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Provider Business Mailing Address
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Address Line | 118 N TIOGA ST STE 302
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City | ITHACA
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State | NY
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Zip | 14850-4343
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Country | US
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Telephone | 607-273-6946
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Fax | 607-256-1680
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Authorized Official
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Title or Position | OWNER
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Name | DR. JED H. WEITZEN
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Credential | PH.D.
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Telephone | 607-273-6946
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 8507
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License Number State | NY
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