Bridgewater Counseling Services PC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904002990 Issued in 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

Last updated

Dec 13, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Scott W Mandeville, LCSWNPI 1437110657

Title

Owner

Phone

(540) 828-3663

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Tax ID family

Bridgewater Counseling Services PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Bridgewater Counseling Services, PC

  • Clinical Social Worker
  • Bridgewater, VA
  • NPI 1700017621
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Scott Weston Mandeville, L.C.S.W., CS.O.T.P.

  • Clinical Social Worker
  • Bridgewater, VA
  • NPI 1437110657
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1216080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355356800000",
    "number": "1891959169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 WEST COLLEGE STREET",
            "city": "BRIDGEWATER",
            "state": "VA",
            "postal_code": "228121124",
            "telephone_number": "540-828-3663",
            "fax_number": "540-828-2322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 WEST COLLEGE STREET",
            "city": "BRIDGEWATER",
            "state": "VA",
            "postal_code": "228121124",
            "telephone_number": "540-828-3663",
            "fax_number": "540-828-2322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGEWATER COUNSELING SERVICES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-15",
        "last_updated": "2012-12-13",
        "status": "A",
        "authorized_official_last_name": "MANDEVILLE",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "540-828-3663",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0812000382",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904002990",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 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, ATC
• Paul Russell Brown II

• Clinical Social Worker in Bridgewater, VA
• Providers in Bridgewater, 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 Dec 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.