Provider Demographics
NPI:1073666038
Name:WEBBER, BRUCE M (LCSW)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:M
Last Name:WEBBER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19105 35TH AVE
Mailing Address - Street 2:APT. I
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-1900
Mailing Address - Country:US
Mailing Address - Phone:646-522-4121
Mailing Address - Fax:
Practice Address - Street 1:35 E 35TH ST
Practice Address - Street 2:SUITE 1-M
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3823
Practice Address - Country:US
Practice Address - Phone:646-522-4121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR055524-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP2576834OtherOXFORD HEALTH