Provider Demographics
NPI:1124443114
Name:WEAVER, AISHWARYA JHA
Entity type:Individual
Prefix:
First Name:AISHWARYA
Middle Name:JHA
Last Name:WEAVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035-4021
Mailing Address - Country:US
Mailing Address - Phone:508-543-2133
Mailing Address - Fax:
Practice Address - Street 1:30 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-4021
Practice Address - Country:US
Practice Address - Phone:508-543-2133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-27
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11277103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist