Provider Demographics
NPI:1659488203
Name:WEAVER, JOYCE R (MS)
Entity Type:Individual
Prefix:MS
First Name:JOYCE
Middle Name:R
Last Name:WEAVER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:JOYCE
Other - Middle Name:I
Other - Last Name:ROSNEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 JENKINS ST
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-2729
Mailing Address - Country:US
Mailing Address - Phone:631-224-1357
Mailing Address - Fax:
Practice Address - Street 1:265 E MAIN ST
Practice Address - Street 2:ROOM 164
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2740
Practice Address - Country:US
Practice Address - Phone:631-224-5979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000079-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health