Provider Demographics
NPI:1952874794
Name:WEAVER, AMY LYNN (LSW)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNN
Last Name:WEAVER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PARKSIDE PSYCHOLOGICAL ASSOCIATES
Mailing Address - Street 2:435 CHESTNUT STREET
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335
Mailing Address - Country:US
Mailing Address - Phone:814-807-0881
Mailing Address - Fax:814-807-0883
Practice Address - Street 1:PARKSIDE PSYCHOLOGICAL ASSOCIATES
Practice Address - Street 2:435 CHESTNUT STREET
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335
Practice Address - Country:US
Practice Address - Phone:814-807-0881
Practice Address - Fax:814-807-0883
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW135747104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker