Renetta Diane Weaver, LICSW & LCSW-C

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

19932 Issued in MD

Practice address

2893 Cameo PL
Bryans Road, MD 20616-7010

Phone

(301) 455-5032

Fax

(301) 455-5032

NPI assigned

Jun 22, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1488931200000",
    "number": "1780620153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2893 CAMEO PL",
            "city": "BRYANS ROAD",
            "state": "MD",
            "postal_code": "206167010",
            "telephone_number": "301-455-5032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2893 CAMEO PL",
            "city": "BRYANS ROAD",
            "state": "MD",
            "postal_code": "206167010",
            "telephone_number": "301-455-5032",
            "fax_number": "301-455-5032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEAVER",
        "first_name": "RENETTA",
        "middle_name": "DIANE",
        "name_prefix": "Mrs.",
        "credential": "LICSW & LCSW-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-22",
        "last_updated": "2017-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "DC",
            "license": "LC50078177",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "19932",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Jack Swartz, RPH
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• Vanessa Tran, MPA
• University of Maryland Community Medical Group, Inc.
• Jessica Walker
• Tracy Woods-Sam
• Yogeshvar LLC
• Yogeshvar LLC
• Theresa Carlyle Young'Rosier

• Clinical Social Worker in Bryans Road, MD
• Providers in Bryans Road, MD by specialty
• Clinical Social Worker in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.