Provider Demographics
NPI:1730581679
Name:WEISS, JAMIE SUE (,PHD, MA)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:SUE
Last Name:WEISS
Suffix:
Gender:F
Credentials:,PHD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3275 W HILLSBORO BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-9474
Mailing Address - Country:US
Mailing Address - Phone:615-213-6327
Mailing Address - Fax:561-516-8077
Practice Address - Street 1:3275 W HILLSBORO BLVD STE 300
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-9474
Practice Address - Country:US
Practice Address - Phone:615-213-6327
Practice Address - Fax:561-516-8087
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2947101YM0800X
FL106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health