Revel Lerae Weber, MSW, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

27232 Issued in MN

Practice address

316 6TH Ave SW
Perham, MN 56573-1508

Phone

(218) 346-2322

NPI assigned

Apr 17, 2018

Last updated

Apr 16, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Infinity Therapy LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Waubun, MN
  • NPI 1316692262
  NPD Authorized official
• White Earth Band of Ojibwe - Indian Child Welfare

  • Professional Counselor
  • Ogema, MN
  • NPI 1457639551

  Clinical

  NPD (past)

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

{
    "created_epoch": "1523923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618531200000",
    "number": "1861989691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 452",
            "city": "PERHAM",
            "state": "MN",
            "postal_code": "565730452",
            "telephone_number": "218-346-2322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 6TH AVE SW",
            "city": "PERHAM",
            "state": "MN",
            "postal_code": "565731508",
            "telephone_number": "218-346-2322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEBER",
        "first_name": "REVEL",
        "middle_name": "LERAE",
        "name_prefix": "Mrs.",
        "credential": "MSW, LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-17",
        "last_updated": "2021-04-16",
        "certification_date": "2021-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "27232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nolan Wade, RBT
• Ronica Marie Wahl, NP
• Duane Wallace, RPH
• Tiffany Washek
• Britni Waskosky
• Teresa Wenaas
• Mariah Wendt
• Steven J Wendt, D.C.
• Keri Werner
• Amanda Weston

• Clinical Social Worker in Perham, MN
• Providers in Perham, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2021; 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.