Provider Demographics
NPI:1902111255
Name:WEBER, KATIE (KATIE WEBER, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:
Last Name:WEBER
Suffix:
Gender:F
Credentials:KATIE WEBER, LCSW
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:VALLEJO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:KATIE WEBER, LCSW
Mailing Address - Street 1:765 N MAIN ST STE 146
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-1440
Mailing Address - Country:US
Mailing Address - Phone:951-444-5820
Mailing Address - Fax:951-479-3550
Practice Address - Street 1:765 N MAIN ST STE 146
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92880-1440
Practice Address - Country:US
Practice Address - Phone:951-444-5820
Practice Address - Fax:951-479-3550
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041S0200X
CA759411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool