MEDICARE: MICHAEL LOUIS WEED MSW

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	1041C0700X	Clinical Social Worker	813-C	AR

General Provider Information

NPI Number	:	1447257118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL LOUIS WEED MSW

Provider Business Mailing Address
First Line	:	510 BUTLER AVE
Second Line	:
City	:	MARTINSBURG
State	:	WV
Zip	:	25401-9990
Country	:	US
Telephone Number	:	304-263-0811
Fax Number	:	304-264-3989

Provider Business Practice Location Address
First Line	:	510 BUTLER AVE
Second Line	:
City	:	MARTINSBURG
State	:	WV
Zip	:	25401-9990
Country	:	US
Telephone Number	:	304-263-0811
Fax Number	:	304-264-3989

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/08/2007

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