Provider Demographics
NPI:1003957671
Name:PHILIP L WEBER, PSY.D., PC
Entity type:Organization
Organization Name:PHILIP L WEBER, PSY.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:610-578-0974
Mailing Address - Street 1:103 VICTORIA CT
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-8502
Mailing Address - Country:US
Mailing Address - Phone:610-578-0974
Mailing Address - Fax:
Practice Address - Street 1:103 VICTORIA CT
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-8502
Practice Address - Country:US
Practice Address - Phone:610-578-0974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005914L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA676514Medicare ID - Type Unspecified