Provider Demographics
NPI:1982268348
Name:WEAVER, JESSICA RW (LMHC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RW
Last Name:WEAVER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 HUXLEY DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4817
Mailing Address - Country:US
Mailing Address - Phone:716-982-7244
Mailing Address - Fax:
Practice Address - Street 1:5350 MAIN ST STE 10
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5338
Practice Address - Country:US
Practice Address - Phone:716-777-1083
Practice Address - Fax:716-204-8387
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY29537101YA0400X
NY007476101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)