MEDICARE: MS. KERRIE WEAVER M.F.T.

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	106H00000X	Marriage & Family Therapist	39624	CA

General Provider Information

NPI Number	:	1982757944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KERRIE WEAVER M.F.T.

Provider Business Mailing Address
First Line	:	515 S CATALINA AVE FRNT
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-4198
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	423 S PCH HWY STE 102
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-3731
Country	:	US
Telephone Number	:	310-792-1823
Fax Number	:	310-375-7332

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

Provider Enumeration Date	:	01/20/2007
Last Update Date	:	09/25/2019

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