Provider Demographics
NPI:1316127186
Name:LINEAWEAVER, TIMOTHY H (LMAC, CADC-1)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:H
Last Name:LINEAWEAVER
Suffix:
Gender:M
Credentials:LMAC, CADC-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649
Mailing Address - Country:US
Mailing Address - Phone:508-477-7090
Mailing Address - Fax:508-477-7028
Practice Address - Street 1:107 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649
Practice Address - Country:US
Practice Address - Phone:508-477-7090
Practice Address - Fax:508-477-7028
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4081101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health