Sage Annaleise Bolte, PHD, LCSW, OSW-C

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904006107 Issued in VA

Practice address

12821 Tewksbury Dr
Herndon, VA 20171-2428

Phone

(703) 403-2120

NPI assigned

Nov 23, 2012

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 names 1

• Sage Annaleise Bolte-Mullen Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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 and National Provider Directory roles.

• Capital Palliative Care Consultants, LLC

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Falls Church, VA
  • NPI 1275541013
  NPD (past)

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

{
    "created_epoch": "1353628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1353628800000",
    "number": "1669716015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12821 TEWKSBURY DR",
            "city": "HERNDON",
            "state": "VA",
            "postal_code": "201712428",
            "telephone_number": "703-403-2120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12821 TEWKSBURY DR",
            "city": "HERNDON",
            "state": "VA",
            "postal_code": "201712428",
            "telephone_number": "703-403-2120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLTE",
        "first_name": "SAGE",
        "middle_name": "ANNALEISE",
        "name_prefix": "Dr.",
        "credential": "PHD, LCSW, OSW-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-11-23",
        "last_updated": "2012-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904006107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAGE",
            "last_name": "BOLTE-MULLEN",
            "middle_name": "ANNALEISE",
            "credential": "PHD, LCSW, OSW-C",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Victoria Block, PT
• Bloom Home Care LLC
• Thea N Boatswain, MS, RD
• Elisabeth Anne Boettke, NP
• Ioana Boie, PHD
• Aruna Borkar, MSPT
• BPT Wellness
• Jocelyn Brackett, FNP-B.C.
• Herman Singh Brar, R.N
• Alnora L Brassell, NURSE PRACTITIONER

• Clinical Social Worker in Herndon, VA
• Providers in Herndon, 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 23, 2012; 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.