Provider Demographics
NPI:1437173788
Name:WEAVER, STEPHANY MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHANY
Middle Name:MARIE
Last Name:WEAVER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:STEPHANY
Other - Middle Name:MARIE
Other - Last Name:COOMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1444 JASMINE WAY
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-6100
Mailing Address - Country:US
Mailing Address - Phone:727-244-1379
Mailing Address - Fax:
Practice Address - Street 1:1444 JASMINE WAY
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-6100
Practice Address - Country:US
Practice Address - Phone:727-244-1379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005061A1041C0700X
FLSW 86451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical