Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 125005 | MS |
NPI | 1053921098 |
---|---|
Provider Name | Dr. Betty Swain Weiss |
First Address | Terry, MS 39170-7116 |
Second Address | Terry, MS 39170-7116 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2020 |
Last Update Date | 04/08/2020 |