Provider Demographics
NPI:1164703229
Name:WEBER, MARY ANN GEISER (LMSW)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:GEISER
Last Name:WEBER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27432 US HIGHWAY 20
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46628-4543
Mailing Address - Country:US
Mailing Address - Phone:269-313-5095
Mailing Address - Fax:
Practice Address - Street 1:59554 COUNTY LINE RD # 2
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-9218
Practice Address - Country:US
Practice Address - Phone:269-313-5095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010843621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical