Provider Demographics
NPI:1952030751
Name:WEAVER, BRITTANY (MED, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9305 HUDSON LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-1046
Mailing Address - Country:US
Mailing Address - Phone:502-386-6754
Mailing Address - Fax:
Practice Address - Street 1:5895 KY-146
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014
Practice Address - Country:US
Practice Address - Phone:502-386-6754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY277983103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst