Provider Demographics
NPI:1679170443
Name:WEAVER, STEPHEN FRANCIS (LLMSW)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:FRANCIS
Last Name:WEAVER
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 BANBURY RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-5200
Mailing Address - Country:US
Mailing Address - Phone:517-881-3986
Mailing Address - Fax:
Practice Address - Street 1:1907 BANBURY RD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-5200
Practice Address - Country:US
Practice Address - Phone:517-881-3986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511107991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical