Provider Demographics
NPI:1376745463
Name:KING-WEAVER, ELIZABETH
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:KING-WEAVER
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:3471 N FEDERAL HWY
Mailing Address - Street 2:SUITE 410
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1019
Mailing Address - Country:US
Mailing Address - Phone:954-903-9426
Mailing Address - Fax:954-533-8616
Practice Address - Street 1:3471 N FEDERAL HWY
Practice Address - Street 2:SUITE 410
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1019
Practice Address - Country:US
Practice Address - Phone:954-903-9426
Practice Address - Fax:954-533-8616
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 58331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ148SOtherBCBS