Kelly Diane Weber, LISW-S

Primary specialty

Social WorkerTaxonomy code 104100000X

License

1700858 Issued in OH

Practice address

VA Behavioral Health and Wellness Center
4600 Smith Road
Norwood, OH 45212

Phone

(513) 861-3100

Fax

(513) 487-7017

NPI assigned

Sep 23, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Miss Kelly Diane McDermott Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1569196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569196800000",
    "number": "1013568930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "VA BEHAVIORAL HEALTH AND WELLNESS CENTER",
            "address_2": "4600 SMITH ROAD",
            "city": "NORWOOD",
            "state": "OH",
            "postal_code": "45212",
            "telephone_number": "513-861-3100",
            "fax_number": "513-487-7017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "VA BEHAVIORAL HEALTH AND WELLNESS CENTER",
            "address_2": "4600 SMITH ROAD",
            "city": "NORWOOD",
            "state": "OH",
            "postal_code": "45212",
            "telephone_number": "513-861-3100",
            "fax_number": "513-487-7017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEBER",
        "first_name": "KELLY",
        "middle_name": "DIANE",
        "name_prefix": "Mrs.",
        "credential": "LISW-S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-23",
        "last_updated": "2019-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "1700585",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "1700858",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "MCDERMOTT",
            "middle_name": "DIANE",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Social Worker in Norwood, OH
• Providers in Norwood, OH by specialty
• Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.