Bridgewater Counseling Services PC
Organization Active NPI Clinical Social Worker · Bridgewater, VA
NPI 1891959169 · NPPES record last updated Dec 13, 2012
Key facts
- NPI
- 1891959169
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 0904002990 (VA)
- Legal business name
- BRIDGEWATER COUNSELING SERVICES PC
- Practice address
- 108 West College Street
Bridgewater, VA 22812-1124 - Phone
- (540) 828-3663
- Fax
- (540) 828-2322
- NPI assigned
- Jul 15, 2008
- Organization subpart
- No
Authorized official
- Name
- Scott W Mandeville, LCSW
- Title
- Owner
- Phone
- (540) 828-3663
Corporate family (same tax ID) 1
Practitioners 1
-
Scott Weston Mandeville, L.C.S.W., CS.O.T.P.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050203000431 | VA | Part B Supplier - Clinic/Group Practice | 1052362324 |
Receives reassigned benefits from 1 practitioner Practice locations: Bridgewater, VA |
National Provider Directory
- Tax ID family
- Bridgewater Counseling Services PC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker |
1041C0700X | 0812000382 | VA | |
| Clinical Social Worker |
1041C0700X | 0904002990 | VA | Yes |
Addresses
Primary practice location
108 West College Street
Bridgewater, VA 22812-1124
Mailing address
108 West College Street
Bridgewater, VA 22812-1124
Phone (540) 828-3663
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891959169 | Medicaid | VA | |
| 219164 | Other | VA | COM-PSYCH |
Other providers in Bridgewater, VA
- Pierce Marcel Billups
- Brianna Kierra Blackshear
- Devontay M Blair
- McKenna Boswell
- Bridgewater Chiropractic Center
- Bridgewater Counseling Services, PC
- Bridgewater Healthcare Pharmacy
- Bridgewater Home, Inc.
- Daniel Ryan Brown
- Paul Russell Brown II
All providers in Bridgewater, VA · Clinical Social Worker in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 13, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.