Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY5615 | CA |
Y | 103T00000X | Psychologist | PSY5615 | CA |
N | 103G00000X | Clinical Psychologist | PSY5615 | CA |
N | 103TC0700X | Clinical Psychologist | PSY5615 | CA |
N | 103TH0100X | Health Service | PSY5615 | CA |
NPI | 1306868518 |
---|---|
Provider Name | Dr. John Weir |
First Address | San Anselmo, CA 94960-2314 |
Second Address | San Rafael, CA 94901-3707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 27/06/2011 |