Provider Demographics
NPI:1073660494
Name:WEAVER, KORY C (LCSW)
Entity type:Individual
Prefix:
First Name:KORY
Middle Name:C
Last Name:WEAVER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 DEBBIE LN
Mailing Address - Street 2:
Mailing Address - City:AVERILL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12018-2732
Mailing Address - Country:US
Mailing Address - Phone:518-283-8420
Mailing Address - Fax:
Practice Address - Street 1:2 DEBBIE LN
Practice Address - Street 2:
Practice Address - City:AVERILL PARK
Practice Address - State:NY
Practice Address - Zip Code:12018-2732
Practice Address - Country:US
Practice Address - Phone:518-992-6741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health