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General NPI Number Information
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NPI Number | 1538378013
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Entity Type | Organization
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Legal Business Name | DR. WEISE, INC.
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 05/08/2019
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Provider Practice Location Address
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Address Line | 224 DATURA ST STE 414
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-5632
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Country | US
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Telephone | 561-707-6311
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8085
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-0085
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Country | US
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Telephone | 561-845-5524
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Fax | 561-845-0680
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DENNIS MILTON WEISE
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Credential | PH.D.
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Telephone | 561-707-6311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | PY0003680
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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