Individual provider Active NPI

Dennis Weise

  • Clinical Psychologist
  • West Palm Beach, FL
National Provider Identifier
1497972855
Registry record updated May 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY3680 Issued in FL
Practice address
224 Datura St Ste 414
West Palm Beach, FL 33401-5632
Phone
(561) 707-6311
NPI assigned
Apr 19, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent Psychologist 103TC2200X PY 3680 FL
Developmental Therapist 222Q00000X PY3680 FL
Clinical Psychologist 103TC0700X PY3680 FL Primary

Addresses

Primary practice location

224 Datura St Ste 414
West Palm Beach, FL 33401-5632

Mailing address

224 Datura St Ste 414
West Palm Beach, FL 33401-5632
Phone (561) 707-6311

Other identifiers 1

IdentifierTypeStateIssuer
810932000MedicaidFL

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
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PY3680FLMDClinical Psychologist
PY 3680FLMDClinical Child & Adolescent Psychologist

NPI Registry JSON

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

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557187200000",
    "number": "1497972855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224 DATURA ST STE 414",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334015632",
            "telephone_number": "561-707-6311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "224 DATURA ST STE 414",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334015632",
            "telephone_number": "561-707-6311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEISE",
        "first_name": "DENNIS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-19",
        "last_updated": "2019-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "FL",
            "license": "PY 3680",
            "primary": false
        },
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": "FL",
            "license": "PY3680",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY3680",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "810932000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Palm Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.