Provider Demographics
NPI:1578778643
Name:WEBER, IHANDE MARCAYDA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:IHANDE
Middle Name:MARCAYDA
Last Name:WEBER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:IHANDE
Other - Middle Name:MARCAYDA
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:3300 CAPITOL AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1514
Mailing Address - Country:US
Mailing Address - Phone:510-574-2032
Mailing Address - Fax:510-574-2054
Practice Address - Street 1:3300 CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1514
Practice Address - Country:US
Practice Address - Phone:510-574-2032
Practice Address - Fax:510-574-2054
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS21531101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ06719ZMedicare PIN
CAZZZ06716ZMedicare PIN