Provider Demographics
NPI:1295003259
Name:WEAFER, ALICE MARX (LCSWR)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:MARX
Last Name:WEAFER
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 ROUTE 312
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-3711
Mailing Address - Country:US
Mailing Address - Phone:845-279-3058
Mailing Address - Fax:845-279-3954
Practice Address - Street 1:570 ROUTE 312
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-3711
Practice Address - Country:US
Practice Address - Phone:845-279-3058
Practice Address - Fax:845-279-3954
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0463181041C0700X
NY1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical