Provider Demographics
NPI:1245412642
Name:WEBER, MICHELE (LCSW)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:
Last Name:WEBER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:DR
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:FATAL-WEBER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:237 RACE ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-4823
Mailing Address - Country:US
Mailing Address - Phone:408-971-9822
Mailing Address - Fax:408-971-9820
Practice Address - Street 1:237 RACE ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-4823
Practice Address - Country:US
Practice Address - Phone:408-971-9822
Practice Address - Fax:408-971-9820
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CALCS 262811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical