Provider Demographics
NPI:1356552285
Name:WEAVER, ROSALIND ANNE (LISW-S)
Entity type:Individual
Prefix:
First Name:ROSALIND
Middle Name:ANNE
Last Name:WEAVER
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:452 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-2815
Mailing Address - Country:US
Mailing Address - Phone:937-653-8965
Mailing Address - Fax:
Practice Address - Street 1:1522 E US HIGHWAY 36
Practice Address - Street 2:STE A
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-9738
Practice Address - Country:US
Practice Address - Phone:937-653-8965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00086131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical