Provider Demographics
NPI:1831591098
Name:WEBER, STACY LEE (PHD)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:LEE
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 1:17665 RACCOON CT
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-6324
Mailing Address - Country:US
Mailing Address - Phone:408-612-8460
Mailing Address - Fax:
Practice Address - Street 1:2155 S BASCOM AVE STE 103
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-3200
Practice Address - Country:US
Practice Address - Phone:262-719-8185
Practice Address - Fax:408-559-9024
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3291-57103TC0700X
CA31020103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical