Provider Demographics
NPI:1639460447
Name:WEBER, JULIA VLADA (PMHNP)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:VLADA
Last Name:WEBER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3043 STATE ROUTE 4
Mailing Address - Street 2:
Mailing Address - City:HUDSON FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12839
Mailing Address - Country:US
Mailing Address - Phone:518-747-2284
Mailing Address - Fax:
Practice Address - Street 1:3043 STATE ROUTE 4
Practice Address - Street 2:
Practice Address - City:HUDSON FALLS
Practice Address - State:NY
Practice Address - Zip Code:12839-9632
Practice Address - Country:US
Practice Address - Phone:151-874-7228
Practice Address - Fax:518-747-2284
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4022352084P0800X
NY633667163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000429302001OtherBLUE SHIELD OF NORTHEASTERN NY