Provider Demographics
NPI:1558464826
Name:WEBER, BRANDY A (LCSW)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:A
Last Name:WEBER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 77
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14129-0077
Mailing Address - Country:US
Mailing Address - Phone:716-532-9942
Mailing Address - Fax:
Practice Address - Street 1:960 WEST MAPLE COURT
Practice Address - Street 2:
Practice Address - City:ELMA
Practice Address - State:NY
Practice Address - Zip Code:14059
Practice Address - Country:US
Practice Address - Phone:716-805-1555
Practice Address - Fax:716-805-1444
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070408-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P35730Medicare UPIN
NYCC6938Medicare ID - Type Unspecified