Individual provider Active NPI

Leigh Anne Mehldau, LCSW

  • Clinical Social Worker
  • Vernon, CT
National Provider Identifier
1396857991
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
004726 Issued in CT
Practice address
933 Hartford Tpke
Vernon, CT 06066-4407
Phone
(860) 872-7696
Fax
(860) 871-0252
NPI assigned
Aug 31, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 004726 CT Primary

Addresses

Primary practice location

933 Hartford Tpke
Vernon, CT 06066-4407

Mailing address

160 Overhill Dr
Berlin, CT 06037-2316
Phone (860) 558-9595

Other identifiers 2

IdentifierTypeStateIssuer
P2892653OtherCTOXFORD PROV NUMBER
140004726CT04OtherCTBLUE SHIELD PROV NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
004726CTMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1396857991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 OVERHILL DR",
            "city": "BERLIN",
            "state": "CT",
            "postal_code": "060372316",
            "telephone_number": "860-558-9595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "933 HARTFORD TPKE",
            "city": "VERNON",
            "state": "CT",
            "postal_code": "060664407",
            "telephone_number": "860-872-7696",
            "fax_number": "860-871-0252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEHLDAU",
        "first_name": "LEIGH ANNE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "004726",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD PROV NUMBER",
            "identifier": "P2892653",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROV NUMBER",
            "identifier": "140004726CT04",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vernon, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.