Provider Demographics
NPI:1710302021
Name:WEAVER, REGINA (LCSW-C)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 GORSUCH AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-3602
Mailing Address - Country:US
Mailing Address - Phone:410-467-4121
Mailing Address - Fax:410-467-6709
Practice Address - Street 1:949 GORSUCH AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-3602
Practice Address - Country:US
Practice Address - Phone:410-467-4121
Practice Address - Fax:410-467-6709
Is Sole Proprietor?:No
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD114181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical