MEDICARE: MR. WILLIAM C. WEBER M.S., LCSW, CEAP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	34002448A	IN
2	101Y00000X	Counselor	35000410A	IN

General Provider Information

NPI Number	:	1053420372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM C. WEBER M.S., LCSW, CEAP

Provider Business Mailing Address
First Line	:	6201 CONSTITUTION DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-1517
Country	:	US
Telephone Number	:	260-432-0696
Fax Number	:	260-436-5795

Provider Business Practice Location Address
First Line	:	6201 CONSTITUTION DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-1517
Country	:	US
Telephone Number	:	260-432-0696
Fax Number	:	260-436-5795

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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