Provider Demographics
NPI:1023349073
Name:WEBER, SUSAN ELAINE (PSYD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ELAINE
Last Name:WEBER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 333
Mailing Address - Street 2:
Mailing Address - City:FLINT HILL
Mailing Address - State:VA
Mailing Address - Zip Code:22627-0333
Mailing Address - Country:US
Mailing Address - Phone:540-671-3563
Mailing Address - Fax:703-783-0099
Practice Address - Street 1:323 ZACHARY TAYLOR HWY
Practice Address - Street 2:
Practice Address - City:FLINT HILL
Practice Address - State:VA
Practice Address - Zip Code:22627-1867
Practice Address - Country:US
Practice Address - Phone:540-671-3563
Practice Address - Fax:703-783-0099
Is Sole Proprietor?:No
Enumeration Date:2010-01-14
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004774103TC2200X, 103TC0700X, 103TC0700X
COPSY3277103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAQ52168F296Medicare PIN
CO1023349073Medicare NSC
COCOAAA2153Medicare PIN