Provider Demographics
NPI:1104002062
Name:WEAGLE, NEVILA BARDHI (LMHC, LMFT)
Entity type:Individual
Prefix:MRS
First Name:NEVILA
Middle Name:BARDHI
Last Name:WEAGLE
Suffix:
Gender:F
Credentials:LMHC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-2520
Mailing Address - Country:US
Mailing Address - Phone:508-753-5425
Mailing Address - Fax:508-753-9625
Practice Address - Street 1:20 CEDAR ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2520
Practice Address - Country:US
Practice Address - Phone:508-753-5425
Practice Address - Fax:508-753-9625
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 42392106H00000X
MA6312101YM0800X
MALMHC 6312101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist