Provider Demographics
NPI:1538378013
Name:DR. WEISE, INC.
Entity type:Organization
Organization Name:DR. WEISE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:MILTON
Authorized Official - Last Name:WEISE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:561-707-6311
Mailing Address - Street 1:PO BOX 8085
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-0085
Mailing Address - Country:US
Mailing Address - Phone:561-845-5524
Mailing Address - Fax:561-845-0680
Practice Address - Street 1:224 DATURA ST STE 414
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-5632
Practice Address - Country:US
Practice Address - Phone:561-707-6311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X, 103TC2200X, 103TC0700X
FLPY0003680251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL080937396Medicaid