Active NPI
Leslie Ann Ellenbogen, L.C.S.W.-A.C.P.
- Clinical Social Worker
- San Antonio, TX
National Provider Identifier
1841339033
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- S12388
- Practice address
- 8623 Starcrest Dr Apt W3
San Antonio, TX 78217-4706 - Phone
- (210) 653-4135
- Fax
- (210) 590-7911
- NPI assigned
- Feb 5, 2007
- Last updated
- Jul 9, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | S12388 | TX | Primary |
Addresses
Primary practice location
8623 Starcrest Dr Apt W3
San Antonio, TX 78217-4706
Mailing address
8623 Starcrest Dr Apt W3
San Antonio, TX 78217-4706
Phone (210) 653-4135
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00S89C | Other | TX | BLUE CROSS BLUE SHIELD |
| 86501Q | Other | TX | BC BS ALPHA OMEGA |
| 060825 | Other | TX | VALUE OPTIONS |
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
| License | State | Type | Specialty |
|---|---|---|---|
| S12388 | TX | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170633600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1841339033",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8623 STARCREST DR APT W3",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782174706",
"telephone_number": "210-653-4135",
"fax_number": "210-590-7911"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8623 STARCREST DR APT W3",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782174706",
"telephone_number": "210-653-4135",
"fax_number": "210-590-7911"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLENBOGEN",
"first_name": "LESLIE",
"middle_name": "ANN",
"credential": "L.C.S.W.-A.C.P.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-05",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TX",
"license": "S12388",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "00S89C",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC BS ALPHA OMEGA",
"identifier": "86501Q",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "060825",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
- James B Elledge, OD, MBA, FAAO
- Richard Elledge, MD
- Ellen Boyle Duncan PLLC
- Ellen W Lin MD PA (Advanced Spine and Pain Center)
- Phyllis Jean Ellena, ADVANCED PRACTICE RN
- Elijah Eller, IONM
- Mary Eller, M.S., CCC-SLP
- Sonja Kristina Ellerbee, MSN, APRN, NP-C
- Jan Rochelle Elleson, M.A., CCC-SLP
- Gaylord Elling, D.D.S
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.