Healthcare Provider Details

I. General information

NPI: 1811497175
Provider Name (Legal Business Name): CHARISSE N WEIR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 MAIN ST STE 303
WEYMOUTH MA
02190-1845
US

IV. Provider business mailing address

110 MAPLE ST
SPRINGFIELD MA
01105-1864
US

V. Phone/Fax

Practice location:
  • Phone: 781-331-7866
  • Fax:
Mailing address:
  • Phone: 413-732-7419
  • Fax: 413-781-1059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: