Provider Demographics
NPI:1205891058
Name:WEBBER, ALAN (LICSW, LADC 1)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:
Last Name:WEBBER
Suffix:
Gender:M
Credentials:LICSW, LADC 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 FLORENCE CT
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02460-1326
Mailing Address - Country:US
Mailing Address - Phone:617-527-4317
Mailing Address - Fax:
Practice Address - Street 1:15 FLORENCE CT
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02460-1326
Practice Address - Country:US
Practice Address - Phone:617-527-4317
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10267351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLADC 1OtherLICENSED ALCOH/DRUG
MALICSWOtherLICENSED CLINICAL SOCIAL
MAWEP 20256Medicare ID - Type UnspecifiedMEDICARE PROVIDER #