Provider Demographics
NPI:1831165984
Name:WEBER, CHRISTINE (PHD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:
Last Name:WEBER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 JACKSON AVENUE
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-2600
Mailing Address - Country:US
Mailing Address - Phone:516-826-4500
Mailing Address - Fax:
Practice Address - Street 1:2234 JACKSON AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-2600
Practice Address - Country:US
Practice Address - Phone:516-826-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015133103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVL9601Medicare ID - Type UnspecifiedMEDICARE ID