Healthcare Provider Details

I. General information

NPI: 1609025386
Provider Name (Legal Business Name): SUSANNE WEIR PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2008
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date: 12/03/2010
Reactivation Date: 05/11/2026

III. Provider practice location address

21432 BROADWAY RD UNIT 572
REDWOOD ESTATES CA
95044-2013
US

IV. Provider business mailing address

21432 BROADWAY RD UNIT 572
REDWOOD ESTATES CA
95044-2013
US

V. Phone/Fax

Practice location:
  • Phone: 408-659-6354
  • Fax:
Mailing address:
  • Phone: 408-659-6354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY24761
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: