Provider Demographics
NPI:1740802404
Name:WEAVER, DELAINIE (BCBA)
Entity Type:Individual
Prefix:
First Name:DELAINIE
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-5904
Mailing Address - Country:US
Mailing Address - Phone:765-587-5244
Mailing Address - Fax:765-281-6914
Practice Address - Street 1:4105 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-5904
Practice Address - Country:US
Practice Address - Phone:765-587-5244
Practice Address - Fax:765-281-6914
Is Sole Proprietor?:No
Enumeration Date:2020-05-15
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-19-74707106S00000X
IN1-20-46733103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician