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NPI Code Detail

MEDICARE: MRS. NEVILA BARDHI WEAGLE LMHC, LMFT

MEDICARE: MRS. NEVILA BARDHI WEAGLE LMHC, LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMFC 42392CA
2101YM0800XMental Health Counselor6312MA
3101YM0800XMental Health CounselorLMHC 6312MA

General Provider Information

NPI Number : 1104002062
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NEVILA BARDHI WEAGLE LMHC, LMFT
Provider Business Mailing Address
First Line : 20 CEDAR ST
Second Line :
City : WORCESTER
State : MA
Zip : 01609-2520
Country : US
Telephone Number : 508-753-5425
Fax Number : 508-753-9625
Provider Business Practice Location Address
First Line : 20 CEDAR ST
Second Line :
City : WORCESTER
State : MA
Zip : 01609-2520
Country : US
Telephone Number : 508-753-5425
Fax Number : 508-753-9625
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2008
Last Update Date : 01/14/2020

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