# KEITH W WEAVER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1053878975
- **Gender:** Man
- **Credential:** MSW, LCSW

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | 096467 | NY | — |
| 1041C0700X | Clinical Social Worker | 2022013753 | MO | — |
| 1041C0700X | Clinical Social Worker | 323944-3501 | UT | Yes |
| 1041C0700X | Clinical Social Worker | TH00946205 | WV | — |

## Other

- **Enumeration date:** 02/27/2019
- **Last updated:** 12/07/2023