Active NPI
Bennie Isaiah Harris
- Clinical Psychologist
- Granada Hills, CA
National Provider Identifier
1154036309
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 94027270
- Practice address
- 16800 Devonshire St Ste 301
Granada Hills, CA 91344-7410 - Phone
- (818) 425-2261
- NPI assigned
- Jan 20, 2023
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 94027270 | CA | Primary |
Addresses
Primary practice location
16800 Devonshire St Ste 301
Granada Hills, CA 91344-7410
Mailing address
14625 Magnolia Blvd Apt 12
Sherman Oaks, CA 91403-1453
Phone (706) 761-8729
Other practice location 1
771 E Daily Dr Ste 310
Camarillo, CA 93010-0784
Phone (818) 425-2261
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 94027270 | Other | CA | BOARD OF PSYCHOLOGY |
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 |
|---|---|---|---|
| 94027270 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1674172800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1738713600000",
"number": "1154036309",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14625 MAGNOLIA BLVD APT 12",
"city": "SHERMAN OAKS",
"state": "CA",
"postal_code": "914031453",
"telephone_number": "706-761-8729"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16800 DEVONSHIRE ST STE 301",
"city": "GRANADA HILLS",
"state": "CA",
"postal_code": "913447410",
"telephone_number": "818-425-2261"
}
],
"practiceLocations": [
{
"address_1": "771 E Daily Dr Ste 310",
"address_purpose": "LOCATION",
"city": "Camarillo",
"state": "CA",
"postal_code": "930100784",
"country_code": "US",
"telephone_number": "818-425-2261",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HARRIS",
"first_name": "BENNIE",
"middle_name": "ISAIAH",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-01-20",
"last_updated": "2025-02-05",
"certification_date": "2025-02-05",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "94027270",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOARD OF PSYCHOLOGY",
"identifier": "94027270",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Granada Hills, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.