Provider Demographics
NPI:1992002869
Name:WELDON, JOHN T (LICSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:T
Last Name:WELDON
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:293 STONEY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878-2731
Mailing Address - Country:US
Mailing Address - Phone:401-624-7339
Mailing Address - Fax:401-624-7339
Practice Address - Street 1:2425 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-4508
Practice Address - Country:US
Practice Address - Phone:508-235-3305
Practice Address - Fax:508-672-2558
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-11
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1034411041C0700X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical