Cayuga Comprehensive Psychological Services, PC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

8507 Issued in NY

Legal business name

CAYUGA COMPREHENSIVE PSYCHOLOGICAL SERVICES, PC

Practice address

118 N Tioga St Ste 302
Ithaca, NY 14850-4343

Phone

(607) 273-6946

Fax

(607) 256-1680

NPI assigned

Nov 17, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Jed H. Weitzen, PH.D.

Title

Owner

Phone

(607) 273-6946

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1510876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510876800000",
    "number": "1528572237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 N TIOGA ST STE 302",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148504343",
            "telephone_number": "607-273-6946",
            "fax_number": "607-256-1680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 N TIOGA ST STE 302",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148504343",
            "telephone_number": "607-273-6946",
            "fax_number": "607-256-1680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAYUGA COMPREHENSIVE PSYCHOLOGICAL SERVICES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-17",
        "last_updated": "2017-11-17",
        "status": "A",
        "authorized_official_last_name": "WEITZEN",
        "authorized_official_first_name": "JED",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "607-273-6946",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "8507",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1497804900",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Ithaca, NY
• Providers in Ithaca, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2017; 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.