Provider Demographics
NPI:1326146713
Name:WEBER, RANDY L (PHD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:L
Last Name:WEBER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SOUTHGATE CT
Mailing Address - Street 2:# 101
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-9663
Mailing Address - Country:US
Mailing Address - Phone:540-568-1876
Mailing Address - Fax:540-574-6076
Practice Address - Street 1:36 SOUTHGATE CT
Practice Address - Street 2:SUITE 102
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-9668
Practice Address - Country:US
Practice Address - Phone:540-568-1876
Practice Address - Fax:540-574-6076
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001674103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7700482Medicaid
VA541672409OtherTAX ID
680000567Medicare PIN
VA680000567Medicare ID - Type UnspecifiedPROVIDER ID