Provider Demographics
NPI:1790813426
Name:WEAVER, JAMES CLAIR (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CLAIR
Last Name:WEAVER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3302 STEUBEN AVE
Mailing Address - Street 2:#4
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2806
Mailing Address - Country:US
Mailing Address - Phone:646-239-9357
Mailing Address - Fax:
Practice Address - Street 1:3302 STEUBEN AVE # 4
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2806
Practice Address - Country:US
Practice Address - Phone:646-239-9357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014825103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical