Active NPI
Lisa Ann Weiss, CP,MA
- Clinical Psychologist
- Bingham Farms, MI
National Provider Identifier
1376942599
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 63010069762
- Practice address
- 30200 Telegraph Rd
Suite 207
Bingham Farms, MI 48025-4502 - Phone
- (248) 712-1129
- Fax
- (248) 569-9410
- NPI assigned
- Aug 14, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist | 103TB0200X | 2050 | MI | |
| Clinical Psychologist | 103TC0700X | 63010069762 | MI | Primary |
Addresses
Primary practice location
30200 Telegraph Rd
Suite 207
Bingham Farms, MI 48025-4502
Mailing address
2511 Tower Hill LN
Rochester Hills, MI 48306-3061
Phone (586) 446-9807
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)
- Enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2050 | MI | MD | Cognitive & Behavioral Psychologist |
| 63010069762 | MI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1407974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475193600000",
"number": "1376942599",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2511 TOWER HILL LN",
"city": "ROCHESTER HILLS",
"state": "MI",
"postal_code": "483063061",
"telephone_number": "586-446-9807",
"fax_number": "248-569-9410"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30200 TELEGRAPH RD",
"address_2": "SUITE 207",
"city": "BINGHAM FARMS",
"state": "MI",
"postal_code": "480254502",
"telephone_number": "248-712-1129",
"fax_number": "248-569-9410"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEISS",
"first_name": "LISA",
"middle_name": "ANN",
"credential": "CP,MA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-08-14",
"last_updated": "2016-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "MI",
"license": "2050",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "63010069762",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bingham Farms, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.