Kenisha Renee Peden, LCSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

34009645A Issued in IN

Practice address

510 Grand Valley Blvd
Martinsville, IN 46151-5883

Phone

(856) 239-3800

NPI assigned

Jan 25, 2023

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Indiana Re-Entry Integrated Services

  • Social Worker
  • Indianapolis, IN
  • NPI 1164137659
  NPD
• Pinnacle Treatment Centers in-II, LLC

  dba Martinsville Treatment Services

  • Methadone Clinic
  • Martinsville, IN
  • NPI 1447922760
  NPD

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

{
    "created_epoch": "1674604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674604800000",
    "number": "1033825831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 GRAND VALLEY BLVD",
            "city": "MARTINSVILLE",
            "state": "IN",
            "postal_code": "461515883",
            "telephone_number": "856-239-3800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 GRAND VALLEY BLVD",
            "city": "MARTINSVILLE",
            "state": "IN",
            "postal_code": "461515883",
            "telephone_number": "856-239-3800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "784 Aerostar Ct",
            "address_purpose": "LOCATION",
            "city": "Avon",
            "state": "IN",
            "postal_code": "461236543",
            "country_code": "US",
            "telephone_number": "219-318-7464",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PEDEN",
        "first_name": "KENISHA",
        "middle_name": "RENEE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-25",
        "last_updated": "2023-01-25",
        "certification_date": "2023-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IN",
            "license": "34009645A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0411150535",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Monica Alise Palmore
• Arlene M. Parker, PMHNP-BC
• Renee Parker, CADAC II, MATS
• Emily Pasch
• Rolan A Pascual, MD
• Benjamin Phan, DDS
• Emma Phelps
• Michael Anthony Phelps, D.C.
• Philip H. Nowak, O.D., P.C.
• Pinnacle Treatment Centers in-I, LLC (Recovery Works Morgan)

• Social Worker in Martinsville, IN
• Providers in Martinsville, IN by specialty
• Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.