Provider Demographics
NPI:1144379322
Name:SCIALABBA WEAVER, DIANE (PSYD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:SCIALABBA WEAVER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 DEER PATH
Mailing Address - Street 2:
Mailing Address - City:BOLTON
Mailing Address - State:MA
Mailing Address - Zip Code:01740-2003
Mailing Address - Country:US
Mailing Address - Phone:978-779-0399
Mailing Address - Fax:
Practice Address - Street 1:60 HODGES AVE # 4
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3034
Practice Address - Country:US
Practice Address - Phone:508-977-3491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7779103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist