MEDICARE: OLIVIA J. WEBER MHC-LP

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	101YM0800X	Mental Health Counselor	18-P121579-01	NY

General Provider Information

NPI Number	:	1699546929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA J. WEBER MHC-LP

Provider Business Mailing Address
First Line	:	2252 N 18TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19132-4313
Country	:	US
Telephone Number	:	704-680-7098
Fax Number	:

Provider Business Practice Location Address
First Line	:	2252 N 18TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19132-4313
Country	:	US
Telephone Number	:	704-680-7098
Fax Number	:

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

Provider Enumeration Date	:	01/15/2024
Last Update Date	:	01/15/2024

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