Provider Demographics
NPI:1831335322
Name:WEBBER, NATHAN TIMOTHY (PHD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:TIMOTHY
Last Name:WEBBER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:TIM
Other - Middle Name:
Other - Last Name:WEBBER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:625 FAIR OAKS AVE
Mailing Address - Street 2:SUITE 390
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-2630
Mailing Address - Country:US
Mailing Address - Phone:800-314-7273
Mailing Address - Fax:800-307-9438
Practice Address - Street 1:625 FAIR OAKS AVE
Practice Address - Street 2:SUITE 390
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-2630
Practice Address - Country:US
Practice Address - Phone:800-314-7273
Practice Address - Fax:800-307-9438
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14927103TC0700X
CA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool