Individual provider Active NPI

Leslie Kripa Samuel Verghese, LCSW-R

  • Clinical Social Worker
  • Bethpage, NY
National Provider Identifier
1639399389
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
R057933 Issued in NY
Practice address
14 Verly CT
Bethpage, NY 11714-5910
Phone
(516) 520-1230
Fax
(718) 454-3584
NPI assigned
Apr 26, 2007
Sex
Male
Sole proprietor
No

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 R057933 NY Primary

Addresses

Primary practice location

14 Verly CT
Bethpage, NY 11714-5910

Mailing address

14 Verly CT
Bethpage, NY 11714-5910
Phone (516) 520-1230

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
R057933NYMDClinical Social Worker
057933NYMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Empress Ambulance Service LLC Past Accepting new patients

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1639399389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 VERLY CT",
            "city": "BETHPAGE",
            "state": "NY",
            "postal_code": "117145910",
            "telephone_number": "516-520-1230",
            "fax_number": "718-454-3584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 VERLY CT",
            "city": "BETHPAGE",
            "state": "NY",
            "postal_code": "117145910",
            "telephone_number": "516-520-1230",
            "fax_number": "718-454-3584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VERGHESE",
        "first_name": "LESLIE",
        "middle_name": "KRIPA SAMUEL",
        "name_prefix": "Mr.",
        "credential": "LCSW-R",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R057933",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bethpage, NY

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.