Active NPI
Kaitlyn D Henris
- Social Worker
- Petaluma, CA
National Provider Identifier
1013622661
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 120449
- Practice address
- 5350 Old Redwood Hwy
Suite 600
Petaluma, CA 94954 - Phone
- (707) 565-1270
- NPI assigned
- Jan 18, 2023
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 120449 | CA | Primary |
Addresses
Primary practice location
5350 Old Redwood Hwy
Suite 600
Petaluma, CA 94954
Mailing address
5350 Old Redwood Hwy
Suite 600
Petaluma, CA 94954
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 120449 | CA | MD | Diagnostic Radiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1674000000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1774828800000",
"number": "1013622661",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5350 OLD REDWOOD HWY",
"address_2": "SUITE 600",
"city": "PETALUMA",
"state": "CA",
"postal_code": "94954"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5350 OLD REDWOOD HWY",
"address_2": "SUITE 600",
"city": "PETALUMA",
"state": "CA",
"postal_code": "94954",
"telephone_number": "707-565-1270"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENRIS",
"first_name": "KAITLYN",
"middle_name": "D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-01-18",
"last_updated": "2026-03-30",
"certification_date": "2026-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "CA",
"license": "120449",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Petaluma, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.