Provider Demographics
NPI:1316546765
Name:WEAVER, SAMANTHA (MSSW)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5409 WELLS CATHEDRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-7036
Mailing Address - Country:US
Mailing Address - Phone:979-324-7388
Mailing Address - Fax:
Practice Address - Street 1:8991 W FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-0419
Practice Address - Country:US
Practice Address - Phone:979-324-7388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-17
Last Update Date:2020-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker