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General NPI Number Information
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NPI Number | 1306868518
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Entity Type | Individual
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Provider Name | JOHN WEIR PH.D.
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Gender | Male
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 06/27/2011
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Provider Practice Location Address
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Address Line | 711 D ST #209
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City | SAN RAFAEL
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State | CA
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Zip | 94901-3707
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Country | US
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Telephone | 415-457-8886
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Fax |
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Provider Business Mailing Address
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Address Line | 200 FORBES AVE
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City | SAN ANSELMO
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State | CA
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Zip | 94960-2314
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Country | US
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Telephone | 415-457-8886
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY5615
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | PSY5615
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY5615
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License Number State | CA
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