Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 0810004774 | VA |
Y | 103TC0700X | Clinical Psychologist | 0810004774 | VA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 0810004774 | VA |
NPI | 1023349073 |
---|---|
Provider Name | Dr. Susan Elaine Weber |
First Address | Flint Hill, VA 22627-0333 |
Second Address | Flint Hill, VA 22627-1867 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2010 |
Last Update Date | 18/09/2018 |