Provider Demographics
NPI:1861242638
Name:WEAVER, JORDAN CHRISTOPHER (LMHC)
Entity type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:CHRISTOPHER
Last Name:WEAVER
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 DEPOT ST
Mailing Address - Street 2:
Mailing Address - City:UPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01568-1600
Mailing Address - Country:US
Mailing Address - Phone:315-569-1554
Mailing Address - Fax:
Practice Address - Street 1:6 DEPOT ST
Practice Address - Street 2:
Practice Address - City:UPTON
Practice Address - State:MA
Practice Address - Zip Code:01568-1600
Practice Address - Country:US
Practice Address - Phone:315-569-1554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9207101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health