Provider Demographics
NPI:1194092544
Name:WEBER, MOLLY ELIZABETH
Entity type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:ELIZABETH
Last Name:WEBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 FOUNTAIN SPRINGS CIR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-5631
Mailing Address - Country:US
Mailing Address - Phone:925-819-1815
Mailing Address - Fax:
Practice Address - Street 1:1880 PLEASANT VALLEY AVE STE F
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-4267
Practice Address - Country:US
Practice Address - Phone:925-819-1815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041981223G0001X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health