Basic Information
Provider Information
NPI: 1184114076
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WEIL
FirstName: LINDSEY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 125 CERVANTES BLVD APT 4
Address2:  
City: SAN FRANCISCO
State: CA
PostalCode: 941231118
CountryCode: US
TelephoneNumber: 2066188151
FaxNumber:  
Practice Location
Address1: 650 CLARK WAY
Address2:  
City: PALO ALTO
State: CA
PostalCode: 943042300
CountryCode: US
TelephoneNumber: 6503265530
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/16/2018
LastUpdateDate: 05/16/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC2200X  Y Behavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent

No ID Information.


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