Leslie D. Mavromatis, LICSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

DP00944782 Issued in WV

Practice address

527 Medical Park Dr
Bridgeport, WV 26330-9008

Phone

(304) 933-3885

Fax

(304) 933-3887

NPI assigned

Feb 8, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WV

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Bridgeport Behavioral ClinicGroup PAC ID 3375534639, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Bridgeport Behavioral Clinic

  • Psychiatry Physician
  • Bridgeport, WV
  • NPI 1538388939
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1486512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486512000000",
    "number": "1922546175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "527 MEDICAL PARK DR",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263309008",
            "telephone_number": "304-933-3885",
            "fax_number": "304-933-3887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "527 MEDICAL PARK DR",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263309008",
            "telephone_number": "304-933-3885",
            "fax_number": "304-933-3887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAVROMATIS",
        "first_name": "LESLIE",
        "middle_name": "D.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-02-08",
        "last_updated": "2017-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WV",
            "license": "DP00944782",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon Mason, OTR/L
• Richard Paul Mastalski, OTR/L
• Gwendolyn S Masterman, MOTR/L
• Chelsea Maust
• Nathaniel Brandon Maving, FNP-BC
• Morgan Mayfield
• Sarah Adrienne McAninch, OTD, OTR/L
• Julie K. McCammon, M.D
• McCandless Enterprises LLC
• Lauren McCarthy, RPH, PHARMD

• Mental Health Counselor in Bridgeport, WV
• Providers in Bridgeport, WV by specialty
• Mental Health Counselor in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2017; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.