Ivette Lopez Bledsoe, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW005801 Issued in GA

Practice address

1360 Caduceus Way BLDG 400
Suite 102
Watkinsville, GA 30677-7300

Phone

(706) 286-8442

NPI assigned

Sep 16, 2006

Last updated

Sep 2, 2016By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Enrolled in CO, GA2 enrollments

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  Clinical, CO, GA

  Medicare reassignment NPD
• Resilia. LLC

  • Community/Behavioral Health Agency
  • Athens, GA
  • NPI 1336347533
  Authorized official Same address or phone

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

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472774400000",
    "number": "1215033212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1341 ARIZONA BND",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "306777774",
            "telephone_number": "678-726-0211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1360 CADUCEUS WAY BLDG 400",
            "address_2": "SUITE 102",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "306777300",
            "telephone_number": "706-286-8442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLEDSOE",
        "first_name": "IVETTE",
        "middle_name": "LOPEZ",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-16",
        "last_updated": "2016-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "627",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW005801",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew James Blackowiak, MSW
• Holly Cheyenne Blalock
• Audrey Blanchard, LMT
• Joseph Blaney, NBC-HWC
• Ashley Keith Blanton, LPC
• Jasen Lee Blehm, MSW
• Blu Iris Counseling
• BMD Telepsychiatry LLC
• Vanessa Bobe-Gonzalez
• Kristina Poss Boccucci, PA

• Clinical Social Worker in Watkinsville, GA
• Providers in Watkinsville, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2016; 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.