Provider Demographics
NPI:1780705178
Name:WEAVER, JENNIFER LAYDEN (LCSW, LCSW-C, RPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LAYDEN
Last Name:WEAVER
Suffix:
Gender:F
Credentials:LCSW, LCSW-C, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 WAGGAMAN CIR
Mailing Address - Street 2:
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-4004
Mailing Address - Country:US
Mailing Address - Phone:703-790-0015
Mailing Address - Fax:
Practice Address - Street 1:1491 CHAIN BRIDGE RD
Practice Address - Street 2:SUITE 302
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-5725
Practice Address - Country:US
Practice Address - Phone:703-598-5559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040046741041C0700X
MD105681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical