Provider Demographics
NPI:1992072532
Name:WESTON, FREDERICK JOSEPH JR (MSW)
Entity type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:JOSEPH
Last Name:WESTON
Suffix:JR
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S 6TH ST
Mailing Address - Street 2:HCGC 14-A
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55487-0999
Mailing Address - Country:US
Mailing Address - Phone:612-348-3072
Mailing Address - Fax:612-677-6248
Practice Address - Street 1:300 S 6TH ST
Practice Address - Street 2:HCGC 14-A
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55487-0999
Practice Address - Country:US
Practice Address - Phone:612-348-3072
Practice Address - Fax:612-677-6248
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNNONE104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker