Provider Demographics
NPI:1679986558
Name:WEBER, AZADEH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AZADEH
Middle Name:
Last Name:WEBER
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 1:6008 W LOOKOUT MOUNTAIN LN
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-7638
Mailing Address - Country:US
Mailing Address - Phone:650-722-4900
Mailing Address - Fax:
Practice Address - Street 1:823 PAULSON CIR
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-3680
Practice Address - Country:US
Practice Address - Phone:650-722-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA34410103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program