NPIMap

Organization Active NPI

Brambleton Assessment and Counseling Center

  • Clinical Social Worker
  • Roanoke, VA
National Provider Identifier
1194142836
Registry record updated Apr 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
0904001648 Issued in VA
Legal business name
BRAMBLETON ASSESSMENT AND COUNSELING CENTER
Practice address
3536 Brambleton Avenue, SW
Suite 3
Roanoke, VA 24018
Phone
(540) 580-0975
Fax
(540) 777-5453
NPI assigned
Mar 19, 2014
Last updated
Apr 18, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2018

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

Authorized official

Name
Ms. Stephanie Ann GoodbarNPI 1730672239
Title
Owner
Phone
(540) 777-7060

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X 0904001648 VA Primary

Addresses

Primary practice location

3536 Brambleton Avenue, SW
Suite 3
Roanoke, VA 24018

Mailing address

3536 Brambleton Ave Ste 3
Roanoke, VA 24018-6500
Phone (540) 777-7060

Other identifiers 2

IdentifierTypeStateIssuer
8916641MedicaidVA
396724OtherVAANTHEM

Other names 1

  • Brambleton Assessment & Counseling Center LLC Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180404001466 VA Part B Supplier - Clinic/Group Practice 5597028514 Receives reassigned benefits from 5 practitioners
Practice locations: Roanoke, VA

National Provider Directory

National Provider Directory

Locations

3536 Brambleton Ave
Ste 3
Roanoke, VA 24018
Phone (540) 580-0975

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1395187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524009600000",
    "number": "1194142836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3536 BRAMBLETON AVE STE 3",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240186500",
            "telephone_number": "540-777-7060",
            "fax_number": "540-777-5453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3536 BRAMBLETON AVENUE, SW",
            "address_2": "SUITE 3",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "24018",
            "telephone_number": "540-580-0975",
            "fax_number": "540-777-5453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAMBLETON ASSESSMENT AND COUNSELING CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-19",
        "last_updated": "2018-04-18",
        "status": "A",
        "authorized_official_last_name": "GOODBAR",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "540-777-7060",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904001648",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8916641",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "396724",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brambleton Assessment & Counseling Center LLC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Brambleton Assessment & Counseling Center LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Roanoke, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.