Provider Demographics
NPI:1982400099
Name:WEAVER, JAMIE (LCSWC)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:WEAVER
Suffix:
Gender:
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 E MAPLE HEIGHTS CT
Mailing Address - Street 2:
Mailing Address - City:RISING SUN
Mailing Address - State:MD
Mailing Address - Zip Code:21911-1899
Mailing Address - Country:US
Mailing Address - Phone:443-993-1579
Mailing Address - Fax:
Practice Address - Street 1:20 CRAIGTOWN RD STE 102
Practice Address - Street 2:
Practice Address - City:PORT DEPOSIT
Practice Address - State:MD
Practice Address - Zip Code:21904-1801
Practice Address - Country:US
Practice Address - Phone:410-642-9172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD289291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical