Active NPI
Michaela Blakey Weaver, LCSW
- Clinical Social Worker
- South Pasadena, CA
National Provider Identifier
1114334497
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW84353
- Practice address
- 625 Fair Oaks Ave Ste 300
South Pasadena, CA 91030-5805 - Phone
- (626) 441-4221
- NPI assigned
- Jul 17, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | ASW66884 | CA | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Clinical Social Worker | 1041C0700X | LCSW84353 | CA | Primary |
Addresses
Primary practice location
625 Fair Oaks Ave Ste 300
South Pasadena, CA 91030-5805
Mailing address
625 Fair Oaks Ave Ste 300
South Pasadena, CA 91030-5805
Phone (626) 441-4221
Other practice location 1
66 Hurlbut St
Pasadena, CA 91105-4025
Phone (626) 441-4221
Other practice location 2
902 S Myrtle Ave
2nd Floor
Monrovia, CA 91016
Phone (626) 357-3258
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ASW66884 | CA | MD | Mental Health Counselor |
| LCSW84353 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1405555200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1700438400000",
"number": "1114334497",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "625 FAIR OAKS AVE STE 300",
"city": "SOUTH PASADENA",
"state": "CA",
"postal_code": "910305805",
"telephone_number": "626-441-4221"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "625 FAIR OAKS AVE STE 300",
"city": "SOUTH PASADENA",
"state": "CA",
"postal_code": "910305805",
"telephone_number": "626-441-4221"
}
],
"practiceLocations": [
{
"address_1": "66 Hurlbut St",
"address_purpose": "LOCATION",
"city": "Pasadena",
"state": "CA",
"postal_code": "911054025",
"country_code": "US",
"telephone_number": "626-441-4221",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "902 S Myrtle Ave",
"address_2": "2nd Floor",
"address_purpose": "LOCATION",
"city": "Monrovia",
"state": "CA",
"postal_code": "91016",
"country_code": "US",
"telephone_number": "626-357-3258",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WEAVER",
"first_name": "MICHAELA",
"middle_name": "BLAKEY",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-07-17",
"last_updated": "2023-11-20",
"certification_date": "2023-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "ASW66884",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCSW84353",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Pasadena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.