Provider Demographics
NPI:1649473927
Name:WEATHERLY, CHARMAINE MARCIA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CHARMAINE
Middle Name:MARCIA
Last Name:WEATHERLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6322 HARBOR BND
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-7048
Mailing Address - Country:US
Mailing Address - Phone:954-977-5023
Mailing Address - Fax:
Practice Address - Street 1:819 NE 26TH ST
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1239
Practice Address - Country:US
Practice Address - Phone:954-390-7654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW85091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical