=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376984773
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMY WEBER LCSW PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2013
-----------------------------------------------------
Last Update Date | 07/13/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 540 PRESIDENT ST SUITE 2G
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11215-1493
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-224-7114
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 540 PRESIDENT ST SUITE 2G
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11215-1493
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE MEMBER
-----------------------------------------------------
Name | AMY ELIZABETH WEBER
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 917-224-7114
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | R059804
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------