Provider Demographics
NPI:1245387869
Name:WIBERG, EMILY ANN
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:ANN
Last Name:WIBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 EUCLID AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-3141
Mailing Address - Country:US
Mailing Address - Phone:415-425-4036
Mailing Address - Fax:
Practice Address - Street 1:2853 GROOM DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-2664
Practice Address - Country:US
Practice Address - Phone:510-222-3946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor