Provider Demographics
NPI:1821437633
Name:WEBBER, KERRY (MSW)
Entity Type:Individual
Prefix:MS
First Name:KERRY
Middle Name:
Last Name:WEBBER
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 1:16 S OAKLAND AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-5214
Mailing Address - Country:US
Mailing Address - Phone:626-297-2339
Mailing Address - Fax:
Practice Address - Street 1:16 S OAKLAND AVE STE 207
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-5214
Practice Address - Country:US
Practice Address - Phone:626-297-2339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2013-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 135071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical