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General NPI Number Information
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NPI Number | 1063655801
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Entity Type | Organization
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Legal Business Name | ANDREW WEAVER, LCSW, LTD.
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Dates
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Enumeration Date | 04/09/2009
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Last Update Date | 08/05/2020
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Provider Practice Location Address
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Address Line | 4507 N RAVENSWOOD AVE STE 104
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City | CHICAGO
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State | IL
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Zip | 60640-5218
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Country | US
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Telephone | 773-612-1342
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Fax | 708-525-0909
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Provider Business Mailing Address
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Address Line | 4507 N RAVENSWOOD AVE STE 104
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City | CHICAGO
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State | IL
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Zip | 60640-5218
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Country | US
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Telephone | 773-612-1342
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Fax | 708-525-0909
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDREW WEAVER
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Credential | LCSW
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Telephone | 773-612-1342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149-009527
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License Number State | IL
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