Doctor Name: | MRS. MARISOL YESENIA WEAVER |
NPI Number: | 1053685180 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 14401 Old Cutler Rd Palmetto Bay, FL - 331581722 |
Business Phone Number: | 7865737010 |
Business Fax Number: | 8888518245 |
Mailing Address: | 14401 Old Cutler Rd, PALMETTO BAY |
State: | FL |
Postal Code: | 331581722 |
Phone Number: | 7865737010 |
Fax Number: | 8888518245 |
NPI Enumeration Date: | 03/07/2012 |
NPI Last Update Date: | 03/07/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |