Jay Ira Weissman, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PS 005215 L Issued in PA

Practice address

12B Smedley LN
Suite 1
Newtown Square, PA 19073-3206

Phone

(610) 356-3724

Fax

(610) 658-0927

NPI assigned

Dec 9, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 10

Medicare fee-for-service enrollment

Enrolled in DE, PA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Clinical Psychologist

Education

Other, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Swarthmore Associates

  • Clinical Psychologist
  • Swarthmore, PA
  • NPI 1891856407
  NPD (past)
• Captains Deck, Inc.

  • Assisted Living Facility
  • Claymont, DE
  • NPI 1154451839
  NPD (past)
• Center for Cognitive & Emotional Well-Being, LLC

  • Clinical Social Worker
  • Wilmington, DE
  • NPI 1891842795
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1104986454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12B SMEDLEY LN",
            "address_2": "SUITE 1",
            "city": "NEWTOWN SQUARE",
            "state": "PA",
            "postal_code": "190733206",
            "telephone_number": "610-356-3724",
            "fax_number": "610-658-0927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12B SMEDLEY LN",
            "address_2": "SUITE 1",
            "city": "NEWTOWN SQUARE",
            "state": "PA",
            "postal_code": "190733206",
            "telephone_number": "610-356-3724",
            "fax_number": "610-658-0927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEISSMAN",
        "first_name": "JAY",
        "middle_name": "IRA",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-09",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PA",
            "license": "PS 005215 L",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "DE",
            "license": "B10000503",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL CHOICE",
            "identifier": "0089393000",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000032392",
            "state": "DE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2547468",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHRISTIANA CARE",
            "identifier": "50294",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS SHIELD",
            "identifier": "628075",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE HEALTH PLAN EAST",
            "identifier": "0089393000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH",
            "identifier": "0089393000",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000033857",
            "state": "DE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMPSYCH",
            "identifier": "234431",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DE BLUE CROSS SHIELD",
            "identifier": "020720PHD",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Warby Parker Inc.
• Samantha Alejandra Ward, MS, CCC-SLP
• Lee Harris Wasserman, D.M.D
• Gordon W. Webster, MD
• Roselle S Weissman-Park, LCSW
• West Chester Nutrition Group LLC
• Alexandra B Weyand, PT, DPT
• White Horse Village Inc.
• White Horse Village Therapy LLC
• Janel Wildermuth

• Clinical Psychologist in Newtown Square, PA
• Providers in Newtown Square, PA by specialty
• Clinical Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.