=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750032843
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SCOTT MITCHELL WEINSTEIN PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2022
-----------------------------------------------------
Last Update Date | 07/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7820 PETERS RD STE E100
-----------------------------------------------------
City | PLANTATION
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33324-4019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-557-0095
-----------------------------------------------------
Fax | 954-423-0901
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7820 PETERS RD STE E100
-----------------------------------------------------
City | PLANTATION
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33324-4019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-557-0095
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PY4789
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------