Active NPI
William Weymouth, PSY.D.
- Clinical Psychologist
- Portland, OR
National Provider Identifier
1124309877
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2135
- Practice address
- 3924 SE Ivon St
Portland, OR 97202-1651 - Phone
- (503) 577-2842
- NPI assigned
- Sep 7, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 2135 | OR | |
| Cognitive & Behavioral Psychologist | 103TB0200X | 2135 | OR | |
| Clinical Psychologist | 103TC0700X | 2135 | OR | Primary |
| Intellectual & Developmental Disabilities Psychologist | 103TM1800X | 2135 | OR | |
| Group Psychotherapy Psychologist | 103TP2701X | 2135 | OR |
Addresses
Primary practice location
3924 SE Ivon St
Portland, OR 97202-1651
Mailing address
3924 SE Ivon St
Portland, OR 97202-1651
Phone (503) 577-2842
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2135 | OR | MD | Intellectual & Developmental Disabilities Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Embodied Psychotherapy Inc | Clinical | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinical Psychologist
- Portland, OR
- NPI 1376963652
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1315353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1315353600000",
"number": "1124309877",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3924 SE IVON ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972021651",
"telephone_number": "503-577-2842"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3924 SE IVON ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972021651",
"telephone_number": "503-577-2842"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEYMOUTH",
"first_name": "WILLIAM",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-09-07",
"last_updated": "2011-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "OR",
"license": "2135",
"primary": false
},
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "OR",
"license": "2135",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "2135",
"primary": true
},
{
"code": "103TM1800X",
"taxonomy_group": "",
"desc": "Psychologist, Intellectual & Developmental Disabilities",
"state": "OR",
"license": "2135",
"primary": false
},
{
"code": "103TP2701X",
"taxonomy_group": "",
"desc": "Psychologist, Group Psychotherapy",
"state": "OR",
"license": "2135",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.