Provider Demographics
NPI:1972534402
Name:WEBER, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:WEBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MARGARET CT
Mailing Address - Street 2:
Mailing Address - City:PRINCETON JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-5114
Mailing Address - Country:US
Mailing Address - Phone:609-897-7889
Mailing Address - Fax:
Practice Address - Street 1:330 N HARRISON ST
Practice Address - Street 2:SUITE 1
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3524
Practice Address - Country:US
Practice Address - Phone:609-915-5803
Practice Address - Fax:609-799-1196
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052967001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ102515Medicare PIN