Provider Demographics
NPI:1861054298
Name:MARIE C. WEIL, PSYD, LLC
Entity type:Organization
Organization Name:MARIE C. WEIL, PSYD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:WEIL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:575-342-1236
Mailing Address - Street 1:PO BOX 922
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88062-0922
Mailing Address - Country:US
Mailing Address - Phone:575-342-1236
Mailing Address - Fax:
Practice Address - Street 1:206 E 11TH ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-5503
Practice Address - Country:US
Practice Address - Phone:575-342-1236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-06
Last Update Date:2023-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM79050093Medicaid