Healthcare Provider Details

I. General information

NPI: 1538226667
Provider Name (Legal Business Name): MARY-JO D. WEBER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2007
Last Update Date: 03/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CROSS RIVER RD
KATONAH NY
10536-3549
US

IV. Provider business mailing address

240 LOCUST LN
IRVINGTON NY
10533-2315
US

V. Phone/Fax

Practice location:
  • Phone: 914-763-8151
  • Fax: 877-810-1175
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF400379
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number001681
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: