Provider Demographics
NPI:1508880345
Name:WEBB, AUDREY H (MSW)
Entity Type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:H
Last Name:WEBB
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6273 BERNHARD AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94805-1633
Mailing Address - Country:US
Mailing Address - Phone:510-287-5988
Mailing Address - Fax:
Practice Address - Street 1:2041 BANCROFT WAY STE 307
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1406
Practice Address - Country:US
Practice Address - Phone:510-287-5988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA$$$$$$$$$OtherPERSONAL CHOICE INDEPENDENT BLUE CROSS
CAZZZ07072ZMedicare PIN