Provider Demographics
NPI:1467484584
Name:WEBER, JOSEPH M (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:M
Last Name:WEBER
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 PENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2144
Mailing Address - Country:US
Mailing Address - Phone:585-389-3073
Mailing Address - Fax:585-271-1129
Practice Address - Street 1:130 ALLENS CREEK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3305
Practice Address - Country:US
Practice Address - Phone:585-271-5610
Practice Address - Fax:585-271-1129
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR070468-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
11545542OtherCAQH IDENTIFIER
NY179886FKOtherPREFERRED CARE, ROCHESTER
11545542OtherCAQH IDENTIFIER