Provider Demographics
NPI:1083893424
Name:WEIL, MARIE C (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:C
Last Name:WEIL
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 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 STREET
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061
Practice Address - Country:US
Practice Address - Phone:575-342-1236
Practice Address - Fax:575-339-2788
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2023-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TA0700X, 103TH0004X
TX36419103TC0700X
NM1494103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth