Provider Demographics
NPI:1851319073
Name:WEIGHT, LARRY DEAN (LICSW)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:DEAN
Last Name:WEIGHT
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22426 SAINT FRANCIS BLVD
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-9670
Mailing Address - Country:US
Mailing Address - Phone:763-753-7310
Mailing Address - Fax:763-753-6529
Practice Address - Street 1:22426 SAINT FRANCIS BLVD
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-9670
Practice Address - Country:US
Practice Address - Phone:763-753-7310
Practice Address - Fax:763-753-6529
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLICSW 41951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical