MEDICARE: YARI WEAVER M.ED

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
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1114323946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YARI WEAVER M.ED

Provider Business Mailing Address
First Line	:	27 JACKSON ST APT 422
Second Line	:
City	:	LOWELL
State	:	MA
Zip	:	01852-2145
Country	:	US
Telephone Number	:	978-710-9274
Fax Number	:

Provider Business Practice Location Address
First Line	:	27 JACKSON ST APT 422
Second Line	:
City	:	LOWELL
State	:	MA
Zip	:	01852-2145
Country	:	US
Telephone Number	:	978-710-9274
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2014
Last Update Date	:	11/05/2014

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Directions to “ YARI WEAVER M.ED” Practice Location

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