Individual
KENNETH I WEISS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
115 MAIN ST, SUITE 2D, NORTH EASTON, MA 02356-1468
(508) 238-7766
(508) 230-5089
Mailing address
115 MAIN STREET, SUITE 2D, NORTH EASTON, MA 02356-1443
(508) 238-7766
(508) 230-5089
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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