Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 4920 | NJ |
N | 103T00000X | Psychologist | 4920 | NJ |
N | 103G00000X | Clinical Psychologist | 4920 | NJ |
N | 103TC0700X | Clinical Psychologist | 4920 | NJ |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 4920 | NJ |
N | 103TS0200X | School Psychologist | 4920 | NJ |
NPI | 1023383767 |
---|---|
Provider Name | Dr. David Weiss |
First Address | South Bound Brook, NJ 08880-1498 |
Second Address | South Bound Brook, NJ 08880-1498 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2012 |
Last Update Date | 13/03/2012 |