Provider Demographics
NPI:1033788617
Name:WEBER, PAULINE BAIN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:PAULINE
Middle Name:BAIN
Last Name:WEBER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:PAULINE
Other - Middle Name:BAIN
Other - Last Name:MATHESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 NE MOTHER JOSEPH PL
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-3200
Mailing Address - Country:US
Mailing Address - Phone:360-514-3843
Mailing Address - Fax:360-514-3499
Practice Address - Street 1:400 NE MOTHER JOSEPH PL
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-3200
Practice Address - Country:US
Practice Address - Phone:360-514-3843
Practice Address - Fax:360-514-3499
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW607442461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty