Provider Demographics
NPI:1801188388
Name:WEAVER, MELANIE A (MS LBS)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:A
Last Name:WEAVER
Suffix:
Gender:F
Credentials:MS LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 SAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17057-2359
Mailing Address - Country:US
Mailing Address - Phone:717-683-5773
Mailing Address - Fax:
Practice Address - Street 1:1630 MANHEIM PIKE STE 2
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-3064
Practice Address - Country:US
Practice Address - Phone:717-945-6491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH006811103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst