Provider Demographics
NPI:1124103486
Name:WEAVER, SARA KATHLEEN (LCSWC)
Entity type:Individual
Prefix:MISS
First Name:SARA
Middle Name:KATHLEEN
Last Name:WEAVER
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2336 GODDARD PARKWAY
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801
Mailing Address - Country:US
Mailing Address - Phone:410-334-6961
Mailing Address - Fax:410-334-6960
Practice Address - Street 1:2336 GODDARD PARKWAY
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801
Practice Address - Country:US
Practice Address - Phone:410-334-6961
Practice Address - Fax:410-334-6960
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD125341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
100085837001OtherAMERICAN PSYCH SYSTEM
DCR968OtherCAREFIRST FEDERAL GROUP
MDLM49EAOtherCAREFIRST BCBS GROUP
2129811OtherUNITED HEALTH CARE MAMSI
517251OtherUHC MAMSI GROUP
DC0022OtherCAREFIRST FEDERAL PIN
MD64342601OtherCAREFIRST BCBS PIN
725797OtherNCPPO PIN
MDLM49EAOtherCAREFIRST BCBS GROUP