MEDICARE: DR. SUSAN ELAINE WEBER PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC2200X	Clinical Child & Adolescent Psychologist	0810004774	VA
2	103TC0700X	Clinical Psychologist	0810004774	VA

General Provider Information

NPI Number	:	1023349073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN ELAINE WEBER PSYD

Provider Business Mailing Address
First Line	:	PO BOX 333
Second Line	:
City	:	FLINT HILL
State	:	VA
Zip	:	22627-0333
Country	:	US
Telephone Number	:	540-671-3563
Fax Number	:	703-783-0099

Provider Business Practice Location Address
First Line	:	323 ZACHARY TAYLOR HWY
Second Line	:
City	:	FLINT HILL
State	:	VA
Zip	:	22627-1867
Country	:	US
Telephone Number	:	540-671-3563
Fax Number	:	703-783-0099

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2010
Last Update Date	:	09/18/2018

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