Healthcare Provider Details

I. General information

NPI: 1831591098
Provider Name (Legal Business Name): STACY LEE WEBER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2014
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 S BASCOM AVE STE 103
CAMPBELL CA
95008-3200
US

IV. Provider business mailing address

17665 RACCOON CT
MORGAN HILL CA
95037-6324
US

V. Phone/Fax

Practice location:
  • Phone: 262-719-8185
  • Fax: 408-559-9024
Mailing address:
  • Phone: 408-612-8460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3291-57
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number31020
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number31020
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: