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NPI Code Detail

MEDICARE: SAMANTHA WEAVER LCSW

MEDICARE: SAMANTHA 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
1104100000XSocial Worker
21041C0700XClinical Social Worker11703-CNV

General Provider Information

NPI Number : 1316546765
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA WEAVER LCSW
Provider Business Mailing Address
First Line : 5409 WELLS CATHEDRAL AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89130-7036
Country : US
Telephone Number : 979-324-7388
Fax Number :
Provider Business Practice Location Address
First Line : 8379 W SUNSET RD STE 140
Second Line :
City : LAS VEGAS
State : NV
Zip : 89113-2248
Country : US
Telephone Number : 979-324-7388
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2020
Last Update Date : 09/16/2024

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Directions to “ SAMANTHA WEAVER LCSW” Practice Location

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