Kristian Bowden Menotti, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

61728 Issued in CA

Practice address

125 Willow Rd Ste 205
Menlo Park, CA 94025-2799

Phone

(919) 696-4712

NPI assigned

Jan 22, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1154475531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33042 SOQUEL ST",
            "city": "UNION CITY",
            "state": "CA",
            "postal_code": "945875558",
            "telephone_number": "919-696-4712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 WILLOW RD STE 205",
            "city": "MENLO PARK",
            "state": "CA",
            "postal_code": "940252799",
            "telephone_number": "919-696-4712"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3622 Haworth Dr",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276097219",
            "country_code": "US",
            "telephone_number": "919-847-3035 x308",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MENOTTI",
        "first_name": "KRISTIAN",
        "middle_name": "BOWDEN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-22",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C005085",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "61728",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3606303",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Menlo Park Pain Relief Center
• Menlo Park Plastic Surgery Center
• Menlo Park Surgical Hospital
• Menlo Speech Pathology Inc.
• Menlo Square Pharmacy
• Meridian Acupuncture, Inc.
• Meridian Medicine LLC
• Ericka Merritt, PT
• Gity Meshkat Razavi, MD,
• Metabolic Psychiatry Labs, Inc

• Clinical Social Worker in Menlo Park, CA
• Providers in Menlo Park, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.