Provider Demographics
NPI:1205153434
Name:WEAVER, AMBER E (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:E
Last Name:WEAVER
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 771
Mailing Address - Street 2:
Mailing Address - City:BARNSTABLE
Mailing Address - State:MA
Mailing Address - Zip Code:02630-0771
Mailing Address - Country:US
Mailing Address - Phone:774-320-0057
Mailing Address - Fax:
Practice Address - Street 1:230 ROUTE 149
Practice Address - Street 2:
Practice Address - City:MARSTONS MILLS
Practice Address - State:MA
Practice Address - Zip Code:02648-1834
Practice Address - Country:US
Practice Address - Phone:508-428-3698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1148721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical