Healthcare Provider Details

I. General information

NPI: 1770592503
Provider Name (Legal Business Name): RICHARD PHILLIP WEBER PSY.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 W PARK AVE SUITE 2
LIBERTYVILLE IL
60048-2567
US

IV. Provider business mailing address

1105 W PARK AVE SUITE 2
LIBERTYVILLE IL
60048-2567
US

V. Phone/Fax

Practice location:
  • Phone: 847-362-5601
  • Fax: 847-362-5611
Mailing address:
  • Phone: 847-362-5601
  • Fax: 847-362-5611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: