Leslie Carol Bardessono, DO

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

20A20848 Issued in CA

Practice address

31764 Casino Dr # 300
Lake Elsinore, CA 92530-2312

Phone

(951) 471-4645

NPI assigned

Apr 13, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in WY, IN, VT3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 3

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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.

• Community Health Network, Inc

  • General Acute Care Hospital
  • Indianapolis, IN
  • NPI 1336119478

  Single Specialty

  Medicare reassignment NPD
• State of Vermont

  • Psychiatric Hospital
  • Berlin, VT
  • NPI 1043567977

  Single Specialty

  Medicare reassignment NPD
• Wyoming Behavioral Institute

  • Psychiatric Hospital
  • Casper, WY
  • NPI 1295709822

  Single Specialty

  Medicare reassignment NPD
• Community Health Network, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Indianapolis, IN
  • NPI 1265477632
  NPD
• State of Vermont

  • Clinical Medical Laboratory
  • Colchester, VT
  • NPI 1215151410
  NPD

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

{
    "created_epoch": "1460505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687305600000",
    "number": "1952755191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2242 S SWEETBRIAR CIR",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474014600",
            "telephone_number": "707-332-9048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31764 CASINO DR # 300",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925302312",
            "telephone_number": "951-471-4645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BARDESSONO",
        "first_name": "LESLIE",
        "middle_name": "CAROL",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-04-13",
        "last_updated": "2023-06-21",
        "certification_date": "2023-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "VT",
            "license": "032.0134075",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "AR",
            "license": "E-12371",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IN",
            "license": "0200619A",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WY",
            "license": "13060A",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "20A20848",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cami Badal
• Mohamed Badr, MD
• Saif U Bajwa, MD
• Jamela Lavina Barber, DPT
• Leah Myhanh Barden, MS.EDUCATION
• Johnathan West Barker, MSW, ASCW
• Linell Barretto
• Byron Martin Barth, L.AC.
• Trevon Bass
• Stephanie Bauerlein, ASW

• Psychiatry Physician in Lake Elsinore, CA
• Providers in Lake Elsinore, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.