Provider Demographics
NPI:1932682200
Name:WEAVER, DOUGLAS PAUL JR (LCSW, CCS)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:PAUL
Last Name:WEAVER
Suffix:JR
Gender:M
Credentials:LCSW, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MOLLISON WAY
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240
Mailing Address - Country:US
Mailing Address - Phone:207-467-2047
Mailing Address - Fax:
Practice Address - Street 1:20 MOLLISON WAY
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240
Practice Address - Country:US
Practice Address - Phone:207-468-2047
Practice Address - Fax:207-645-2372
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC208361041C0700X
MEMC17343104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty