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NPI Code Detail

MEDICARE: KORY C WEAVER LCSW

MEDICARE: KORY C WEAVER LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1073660494
Entity Type Code : Individual
Provider Name (Legal Business Name) : KORY C WEAVER LCSW
Provider Business Mailing Address
First Line : 2 DEBBIE LN
Second Line :
City : AVERILL PARK
State : NY
Zip : 12018-2732
Country : US
Telephone Number : 518-283-8420
Fax Number :
Provider Business Practice Location Address
First Line : 2 DEBBIE LN
Second Line :
City : AVERILL PARK
State : NY
Zip : 12018-2732
Country : US
Telephone Number : 518-992-6741
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2007
Last Update Date : 08/02/2024

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Directions to “ KORY C WEAVER LCSW” Practice Location

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