Active NPI
Kenya Sherrod Sullivan, MSW
- Social Worker
- Oakland, CA
National Provider Identifier
1063613156
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 20040
- Practice address
- 7200 Bancroft
Oakland, CA 94602 - Phone
- (510) 777-3835
- NPI assigned
- May 29, 2007
- Sex
- Male
- Sole proprietor
- No
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 | 20040 | CA | Primary |
Addresses
Primary practice location
7200 Bancroft
Oakland, CA 94602
Mailing address
2054 Central Street
Hercules, CA 94547
Phone (510) 724-6424
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20040 | CA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180396800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1063613156",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2054 CENTRAL STREET",
"city": "HERCULES",
"state": "CA",
"postal_code": "94547",
"telephone_number": "510-724-6424"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7200 BANCROFT",
"city": "OAKLAND",
"state": "CA",
"postal_code": "94602",
"telephone_number": "510-777-3835"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "KENYA",
"middle_name": "SHERROD",
"credential": "MSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "CA",
"license": "20040",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.