Provider Demographics
NPI:1841850781
Name:BRUCE WEBBER LCSW LLC
Entity type:Organization
Organization Name:BRUCE WEBBER LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBBER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-939-6082
Mailing Address - Street 1:95 PARK STREET, SUITE 201
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7282
Mailing Address - Country:US
Mailing Address - Phone:207-939-6082
Mailing Address - Fax:207-782-9001
Practice Address - Street 1:95 PARK STREET, SUITE 201
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7282
Practice Address - Country:US
Practice Address - Phone:207-939-6082
Practice Address - Fax:207-782-9001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Multi-Specialty