Provider Demographics
NPI:1679893622
Name:WEBER, DENISE ELLEN (LLMSW)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:ELLEN
Last Name:WEBER
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:ELLEN
Other - Last Name:CORSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1522 JOY AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-1933
Mailing Address - Country:US
Mailing Address - Phone:517-782-2551
Mailing Address - Fax:517-783-1986
Practice Address - Street 1:1522 JOY AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-1933
Practice Address - Country:US
Practice Address - Phone:517-782-2551
Practice Address - Fax:517-783-1986
Is Sole Proprietor?:No
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010917261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical