Active NPI
Leisa M Rebold
- Clinical Social Worker
- Virginia Beach, VA
National Provider Identifier
1952834210
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 0904008318
- Practice address
- 206 70TH St
Virginia Beach, VA 23451-2005 - Phone
- (757) 563-3007
- NPI assigned
- Apr 4, 2017
- 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 | 0904008318 | VA | Primary |
Addresses
Primary practice location
206 70TH St
Virginia Beach, VA 23451-2005
Mailing address
206 70TH St
Virginia Beach, VA 23451-2005
Phone (757) 778-5080
Other names 1
- Leisa M Brass
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 1, 2025 through Jul 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Reboot Functional Health Care Corporation | Past | Accepting new patients | |
| Beach Counseling, LLC | Clinical | Past | Accepting new patients |
| LHCG Cxcix, LLC | Past | Accepting new patients |
Interoperability endpoints
- leisa.rebold.1@29909.direct.athenahealth.com
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1491264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1708387200000",
"number": "1952834210",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "206 70TH ST",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "234512005",
"telephone_number": "757-778-5080"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "206 70TH ST",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "234512005",
"telephone_number": "757-563-3007"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REBOLD",
"first_name": "LEISA",
"middle_name": "M",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-04-04",
"last_updated": "2024-02-20",
"certification_date": "2024-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "VA",
"license": "0904008318",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "LEISA",
"last_name": "BRASS",
"middle_name": "M",
"credential": "LCSW",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Virginia Beach, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.