Doctor Name: | MS. TAMARA LYN WEAVER |
NPI Number: | 1770618407 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 25342 |
Business Practice Address: | 1600 Bailey Ave Ste 2 Needles, CA - 923633105 |
Business Phone Number: | 7603269272 |
Business Fax Number: | 7603269259 |
Mailing Address: | 1600 Bailey Ave Ste 2, NEEDLES |
State: | CA |
Postal Code: | 923633105 |
Phone Number: | 7603269272 |
Fax Number: | 7603269259 |
NPI Enumeration Date: | 02/22/2007 |
NPI Last Update Date: | 06/11/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 25342 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |