Organization
ANDREW WEAVER, LCSW, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREW WEAVER LCSW (PRESIDENT)
(773) 612-1342
Entity
Organization
Contact information
Practice address
4507 N RAVENSWOOD AVE STE 104, CHICAGO, IL 60640-5218
(773) 612-1342
(708) 525-0909
Mailing address
4507 N RAVENSWOOD AVE STE 104, CHICAGO, IL 60640-5218
(773) 612-1342
(708) 525-0909
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149-009527
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1636406
BLUE CROSS/BLUE SHIELD
IL
Enumeration date
04/09/2009
Last updated
08/05/2020
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