Provider Demographics
NPI:1669543658
Name:WEAVER CLINIC
Entity type:Organization
Organization Name:WEAVER CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:III
Authorized Official - Credentials:PHD
Authorized Official - Phone:781-894-4561
Mailing Address - Street 1:158 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493-2543
Mailing Address - Country:US
Mailing Address - Phone:781-894-4561
Mailing Address - Fax:
Practice Address - Street 1:158 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493-2543
Practice Address - Country:US
Practice Address - Phone:781-894-4561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPY 3083 PR103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty