MEDICARE: MARIE C. WEIL, PSYD, LLC

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	103TH0004X	Health Psychologist
2	103TC0700X	Clinical Psychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861054298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIE C. WEIL, PSYD, LLC

Provider Business Mailing Address
First Line	:	PO BOX 922
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88062-0922
Country	:	US
Telephone Number	:	575-342-1236
Fax Number	:

Provider Business Practice Location Address
First Line	:	206 E 11TH ST
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-5503
Country	:	US
Telephone Number	:	575-342-1236
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	MARIE C WEIL
Credential	:	PSYD
Telephone Number	:	575-342-1236

Provider Enumeration Date	:	07/06/2019
Last Update Date	:	03/25/2023

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