Active NPI
Kathryn R Black, LAC, MT-BC
- Acupuncturist
- Alameda, CA
National Provider Identifier
1104129840
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- 17203
- Practice address
- 2258 Santa Clara Ave Ste 1
Alameda, CA 94501-4473 - Phone
- (510) 814-6900
- NPI assigned
- Dec 20, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | 17203 | CA | Primary |
| Music Therapist | 225A00000X | 08011 | UT |
Addresses
Primary practice location
2258 Santa Clara Ave Ste 1
Alameda, CA 94501-4473
Mailing address
1966 Tice Valley Blvd # 228
Walnut Creek, CA 94595-2203
Phone (480) 818-4277
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 |
|---|---|---|---|
| 17203 | CA | MD | Mental Health Counselor |
| 08011 | UT | MD | Music Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1292803200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1465430400000",
"number": "1104129840",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1966 TICE VALLEY BLVD # 228",
"city": "WALNUT CREEK",
"state": "CA",
"postal_code": "945952203",
"telephone_number": "480-818-4277"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2258 SANTA CLARA AVE STE 1",
"city": "ALAMEDA",
"state": "CA",
"postal_code": "945014473",
"telephone_number": "510-814-6900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "KATHRYN",
"middle_name": "R",
"credential": "LAC, MT-BC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-12-20",
"last_updated": "2016-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "CA",
"license": "17203",
"primary": true
},
{
"code": "225A00000X",
"taxonomy_group": "",
"desc": "Music Therapist",
"state": "UT",
"license": "08011",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Alameda, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.