Provider Demographics
NPI:1700376886
Name:WEAVER, MONICA SUE (LLMSW)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:SUE
Last Name:WEAVER
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32302 SALT RIVER CIR S
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48048-3319
Mailing Address - Country:US
Mailing Address - Phone:586-909-4647
Mailing Address - Fax:
Practice Address - Street 1:198 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-7917
Practice Address - Country:US
Practice Address - Phone:586-466-5960
Practice Address - Fax:586-446-5961
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011024121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical