Provider Demographics
NPI:1013568930
Name:WEBER, KELLY DIANE (LISW-S)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:DIANE
Last Name:WEBER
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:DIANE
Other - Last Name:MCDERMOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:VA BEHAVIORAL HEALTH AND WELLNESS CENTER
Mailing Address - Street 2:4600 SMITH ROAD
Mailing Address - City:NORWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45212
Mailing Address - Country:US
Mailing Address - Phone:513-861-3100
Mailing Address - Fax:513-487-7017
Practice Address - Street 1:VA BEHAVIORAL HEALTH AND WELLNESS CENTER
Practice Address - Street 2:4600 SMITH ROAD
Practice Address - City:NORWOOD
Practice Address - State:OH
Practice Address - Zip Code:45212
Practice Address - Country:US
Practice Address - Phone:513-861-3100
Practice Address - Fax:513-487-7017
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
OH1700585104100000X
OH1700858104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker