Provider Demographics
NPI:1942577572
Name:WEBER, CATHLEEN INGLE (LCSW)
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:INGLE
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 3443
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47402-3443
Mailing Address - Country:US
Mailing Address - Phone:812-272-0538
Mailing Address - Fax:812-331-8249
Practice Address - Street 1:901 S ROGERS ST
Practice Address - Street 2:SUITE 205
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-4756
Practice Address - Country:US
Practice Address - Phone:812-272-0538
Practice Address - Fax:812-331-8249
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005610A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health