Provider Demographics
NPI:1639169576
Name:WESER, CAROL (PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:WESER
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2455 BENNETT VALLEY RD
Mailing Address - Street 2:SUITE B-208
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-5663
Mailing Address - Country:US
Mailing Address - Phone:707-526-2228
Mailing Address - Fax:707-526-2288
Practice Address - Street 1:2455 BENNETT VALLEY RD
Practice Address - Street 2:SUITE B-208
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-5663
Practice Address - Country:US
Practice Address - Phone:707-526-2228
Practice Address - Fax:707-526-2288
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 10753103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OPL107530Medicare ID - Type Unspecified
CAOPL107530Medicare UPIN