Basic Information
| Provider Information | |||||||||
| NPI: | 1619111069 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEAVER | ||||||||
| FirstName: | BRANDI | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 859 WILLARD ST | ||||||||
| Address2: | SUITE 439 | ||||||||
| City: | QUINCY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021697482 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178471909 | ||||||||
| FaxNumber: | 6174719859 | ||||||||
| Practice Location | |||||||||
| Address1: | 859 WILLARD ST | ||||||||
| Address2: | SUITE 439 | ||||||||
| City: | QUINCY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021697482 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178471909 | ||||||||
| FaxNumber: | 6174719859 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2009 | ||||||||
| LastUpdateDate: | 03/07/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.