Provider Demographics
NPI:1447472493
Name:RICHARD P WEBER PSY.D.
Entity type:Organization
Organization Name:RICHARD P WEBER PSY.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-362-5601
Mailing Address - Street 1:1105 W PARK AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-2567
Mailing Address - Country:US
Mailing Address - Phone:847-362-5601
Mailing Address - Fax:
Practice Address - Street 1:1105 W PARK AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-2567
Practice Address - Country:US
Practice Address - Phone:847-362-5601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL706630Medicare ID - Type Unspecified