Healthcare Provider Details

I. General information

NPI: 1124343421
Provider Name (Legal Business Name): EMILY ANN UNVERZAGT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY ANN WEAVER

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 04/09/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 TREASURE HILLS BLVD
HARLINGEN TX
78550-8736
US

IV. Provider business mailing address

3742 CHILDRESS ST
HOUSTON TX
77005-1112
US

V. Phone/Fax

Practice location:
  • Phone: 956-366-4500
  • Fax:
Mailing address:
  • Phone: 248-767-6845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801091937
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number56299
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: