Individual
CAROLINE NICOLE WEISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D, LP
Contact information
Practice address
10705 TOWN SQUARE DR NE STE 100, BLAINE, MN 55449-8185
(763) 236-5400
(763) 236-5350
Mailing address
PO BOX 43, MINNEAPOLIS, MN 55440-0043
(612) 262-1166
(612) 262-9035
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP4614
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
410640700
—
MN
Enumeration date
07/17/2006
Last updated
10/17/2024
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