MEDICARE: DENNIS WEISE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC2200X	Clinical Child & Adolescent Psychologist	PY 3680	FL
2	222Q00000X	Developmental Therapist	PY3680	FL
3	103TC0700X	Clinical Psychologist	PY3680	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497972855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENNIS WEISE

Provider Business Mailing Address
First Line	:	224 DATURA ST STE 414
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-5632
Country	:	US
Telephone Number	:	561-707-6311
Fax Number	:

Provider Business Practice Location Address
First Line	:	224 DATURA ST STE 414
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-5632
Country	:	US
Telephone Number	:	561-707-6311
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	05/07/2019

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Directions to “ DENNIS WEISE ” Practice Location

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