Provider Demographics
NPI:1427091495
Name:WEBER, CHRISTOPHER MICHAEL (MSSA, LISW, LICDC)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:WEBER
Suffix:
Gender:M
Credentials:MSSA, LISW, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 BETH CT
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-9665
Mailing Address - Country:US
Mailing Address - Phone:513-349-3927
Mailing Address - Fax:
Practice Address - Street 1:328 MCGREGOR AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-3135
Practice Address - Country:US
Practice Address - Phone:513-684-7968
Practice Address - Fax:513-684-7953
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH001299101YA0400X
OHI92081041C0700X
KYKY-19151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHWESW27001Medicare ID - Type Unspecified