MEDICARE: DR. ANNA MARIE WEISBERG PH.D.

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	103TC0700X	Clinical Psychologist	14651	CA
2	103TC2200X	Clinical Child & Adolescent Psychologist	14651	CA

General Provider Information

NPI Number	:	1568655017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNA MARIE WEISBERG PH.D.

Provider Business Mailing Address
First Line	:	2827 CONCORD BLVD
Second Line	:
City	:	CONCORD
State	:	CA
Zip	:	94519-2608
Country	:	US
Telephone Number	:	925-685-9670
Fax Number	:	925-685-1528

Provider Business Practice Location Address
First Line	:	2827 CONCORD BLVD
Second Line	:
City	:	CONCORD
State	:	CA
Zip	:	94519-2608
Country	:	US
Telephone Number	:	925-685-9670
Fax Number	:	925-685-1528

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

Provider Enumeration Date	:	08/18/2007
Last Update Date	:	08/18/2007

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