Provider Demographics
NPI:1184267254
Name:WEBER, JUSTINE LAUREEN (PSYD)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:LAUREEN
Last Name:WEBER
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5405
Mailing Address - Country:US
Mailing Address - Phone:775-391-9185
Mailing Address - Fax:
Practice Address - Street 1:120 NEWPORT CENTER DR
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-6916
Practice Address - Country:US
Practice Address - Phone:949-423-9426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-22
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31335103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist