NPIMap

Individual provider Active NPI

Mark Thomas Bleil, LCSW,CSOTP

  • Clinical Social Worker
  • Virginia Beach, VA
National Provider Identifier
1831482736
Registry record updated Apr 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
0904007194 Issued in VA
Practice address
5029 Corporate Woods Dr
Suite 250
Virginia Beach, VA 23462-4376
Phone
(757) 473-3770
Fax
(757) 473-3768
NPI assigned
May 25, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2014

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 0904007194 VA Primary

Addresses

Primary practice location

5029 Corporate Woods Dr
Suite 250
Virginia Beach, VA 23462-4376

Mailing address

5029 Corporate Woods Dr
Suite 250
Virginia Beach, VA 23462-4376
Phone (757) 473-3770

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mind Heart Connection LLC Clinical CurrentSince Jun 7, 2020 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": "1306281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398816000000",
    "number": "1831482736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5029 CORPORATE WOODS DR",
            "address_2": "SUITE 250",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234624376",
            "telephone_number": "757-473-3770",
            "fax_number": "757-473-3768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5029 CORPORATE WOODS DR",
            "address_2": "SUITE 250",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234624376",
            "telephone_number": "757-473-3770",
            "fax_number": "757-473-3768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLEIL",
        "first_name": "MARK",
        "middle_name": "THOMAS",
        "credential": "LCSW,CSOTP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-05-25",
        "last_updated": "2014-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904007194",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Virginia Beach, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2014; 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.