Healthcare Provider Details

I. General information

NPI: 1487366167
Provider Name (Legal Business Name): MARCIA WEISBROT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2022
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 14TH ST
SAN FRANCISCO CA
94114-1288
US

IV. Provider business mailing address

811 14TH ST
SAN FRANCISCO CA
94114-1288
US

V. Phone/Fax

Practice location:
  • Phone: 414-735-5216
  • Fax:
Mailing address:
  • Phone: 414-735-5216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number899
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: