MEDICARE: ELLEN C. WEBER LCSW,DCSW,BCD

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	1041C0700X	Clinical Social Worker	LCSW R016056-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	095726	OTHER	NY	VALUE OPTIONS
2	N5X881	OTHER	NY	BLUE CROSSBLUE SHIELD

General Provider Information

NPI Number	:	1720133093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN C. WEBER LCSW,DCSW,BCD

Provider Business Mailing Address
First Line	:	300 E 40TH ST
Second Line	:	#32C
City	:	NEW YORK
State	:	NY
Zip	:	10016-2188
Country	:	US
Telephone Number	:	212-286-9556
Fax Number	:	212-490-9234

Provider Business Practice Location Address
First Line	:	300 E 40TH ST
Second Line	:	#32C
City	:	NEW YORK
State	:	NY
Zip	:	10016-2188
Country	:	US
Telephone Number	:	212-286-9556
Fax Number	:	212-490-9234

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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