Healthcare Provider Details

I. General information

NPI: 1447257118
Provider Name (Legal Business Name): MICHAEL LOUIS WEED MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 BUTLER AVE
MARTINSBURG WV
25401-9990
US

IV. Provider business mailing address

510 BUTLER AVE
MARTINSBURG WV
25401-9990
US

V. Phone/Fax

Practice location:
  • Phone: 304-263-0811
  • Fax: 304-264-3989
Mailing address:
  • Phone: 304-263-0811
  • Fax: 304-264-3989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number813-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: