Healthcare Provider Details

I. General information

NPI: 1568996106
Provider Name (Legal Business Name): ROBIN ANN WEBER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 ADELINE ST 120
BERKELEY CA
94703-2576
US

IV. Provider business mailing address

3075 ADELINE ST 120
BERKELEY CA
94703-2576
US

V. Phone/Fax

Practice location:
  • Phone: 510-848-1112
  • Fax:
Mailing address:
  • Phone: 510-848-1112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW82009
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: