Provider Demographics
NPI:1568989994
Name:WEAVER, RICHARD DANA JR (CSW, LSW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:DANA
Last Name:WEAVER
Suffix:JR
Gender:M
Credentials:CSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47122-0098
Mailing Address - Country:US
Mailing Address - Phone:317-840-8666
Mailing Address - Fax:
Practice Address - Street 1:8003 MAPLE GROVE DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:IN
Practice Address - Zip Code:47122-9047
Practice Address - Country:US
Practice Address - Phone:317-840-8666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-25
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY252760104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker