Provider Demographics
NPI:1427207851
Name:WEBER, LEWIS H (MA, BCBA)
Entity Type:Individual
Prefix:MR
First Name:LEWIS
Middle Name:H
Last Name:WEBER
Suffix:
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5608 WILDE OAK WAY
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6611
Mailing Address - Country:US
Mailing Address - Phone:941-342-0856
Mailing Address - Fax:
Practice Address - Street 1:5608 WILDE OAK WAY
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6611
Practice Address - Country:US
Practice Address - Phone:941-342-0856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL689221398Medicaid