Individual
JACQUELINE R WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
2030 THISTLE HILL DR STE 202, SPRING GROVE, PA 17362-1161
(717) 843-7348
Mailing address
2200 KERNAN DR OFC 1219, BALTIMORE, MD 21207-6665
(410) 448-2500
(410) 448-6917
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
05792
MD
103T00000X
Psychologist
Primary
PS018080
PA
103TC0700X
Clinical Psychologist
05792
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1841337805
HOSPITAL
MD
Enumeration date
04/21/2013
Last updated
08/09/2022
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