Individual
KENNETH I WEISS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
3881
MA
103TF0000X
Family Psychologist
3881
MA
261QV0200X
VA Clinic/Center
Primary
3881
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1899031
—
MA
01
—
773102
TUFTS HEALTH PLAN
MA
01
—
WO3901
BC BS OF MASSACHUSETTS
MA
Enumeration date
06/26/2006
Last updated
04/19/2017
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