Provider Demographics
NPI:1366972895
Name:WEAVER, MAURA LEIGH (MS BCBA)
Entity type:Individual
Prefix:
First Name:MAURA
Middle Name:LEIGH
Last Name:WEAVER
Suffix:
Gender:F
Credentials:MS BCBA
Other - Prefix:
Other - First Name:MAURA
Other - Middle Name:LEIGH
Other - Last Name:WINTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:152 BRIDGEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-6828
Mailing Address - Country:US
Mailing Address - Phone:256-479-7535
Mailing Address - Fax:
Practice Address - Street 1:230 HUGHES RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-1188
Practice Address - Country:US
Practice Address - Phone:256-489-8660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2017-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-16-24376103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst