Provider Demographics
NPI:1497046148
Name:WEAVER, JOHN D (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:WEAVER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4635 HILLVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-8531
Mailing Address - Country:US
Mailing Address - Phone:610-614-1860
Mailing Address - Fax:610-614-1860
Practice Address - Street 1:4635 HILLVIEW DR
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-8531
Practice Address - Country:US
Practice Address - Phone:610-614-1860
Practice Address - Fax:610-614-1860
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW000169L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical