Provider Demographics
NPI:1477753390
Name:WESKE, MARCIA MYERS (MFT)
Entity Type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:MYERS
Last Name:WESKE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5032 WOODMINSTER LN
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-2614
Mailing Address - Country:US
Mailing Address - Phone:510-482-0551
Mailing Address - Fax:
Practice Address - Street 1:5032 WOODMINSTER LN
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-2614
Practice Address - Country:US
Practice Address - Phone:510-482-0551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31577106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist