1174891212 NPI number — DEBORAH CECILE WEISBERG LMFT, LPCC

Table of content: DEBORAH CECILE WEISBERG LMFT, LPCC (NPI 1174891212)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174891212 NPI number — DEBORAH CECILE WEISBERG LMFT, LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEISBERG
Provider First Name:
DEBORAH
Provider Middle Name:
CECILE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMFT, LPCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174891212
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
864 S. ROBERTSON BLVD.
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-712-5650
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
864 S. ROBERTSON BLVD.
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-712-5650
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/04/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  50800 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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