Healthcare Provider Details

I. General information

NPI: 1053759548
Provider Name (Legal Business Name): EYVETTE MARIE WEAVER-PAULING LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2013
Last Update Date: 06/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10302 GLENMORE DR
ADELPHI MD
20783-1201
US

IV. Provider business mailing address

10302 GLENMORE DR
ADELPHI MD
20783-1201
US

V. Phone/Fax

Practice location:
  • Phone: 301-431-0504
  • Fax:
Mailing address:
  • Phone: 301-431-0504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC302650
License Number StateDC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: