Shelly Bleil, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904011354 Issued in VA

Practice address

522 S Lake Cir
Chesapeake, VA 23322-8371

Phone

(757) 818-1896

NPI assigned

Nov 8, 2019

Last updated

Nov 8, 2019By 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 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Mountain Roots Psychotherapy

  • Clinical Social Worker
  • Chesapeake, VA
  • NPI 1538074562
  NPD (past) Authorized official

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

{
    "created_epoch": "1573171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573171200000",
    "number": "1659916120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "522 S LAKE CIR",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233228371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "522 S LAKE CIR",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233228371",
            "telephone_number": "757-818-1896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLEIL",
        "first_name": "SHELLY",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-11-08",
        "last_updated": "2019-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904011354",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LCSW LICENSE NUMBER",
            "identifier": "0904011354",
            "state": "VA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "Zirklesl818@yahoo.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "522 S Lake Cir",
            "city": "Chesapeake",
            "state": "VA",
            "country_code": "US",
            "postal_code": "233228371",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Maribelle M Blackmon, NP
• Sara Qualls Blaha, LDN, RD
• Heather Lynn Blakley, MS, CCC-SLP
• Tracy Baker Blalock, PHARMD
• Peyton Reisch Blankenship, DPT
• Blessed & Highly Favored Home Health Care LLC
• Blessings Beyond Lessons LLC
• David N. Block, D.C.
• Bloom Psychotherapy Center LLC (Bloom Psychotherapy Center)
• Blooming Minds Therapy LLC

• Clinical Social Worker in Chesapeake, VA
• Providers in Chesapeake, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2019; 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.