Active NPI
Benjamin McKenna, PH.D.
- Clinical Psychologist
- La Jolla, CA
National Provider Identifier
1174076954
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY26510
- Practice address
- 3252 Holiday CT
La Jolla, CA 92037-0027 - Phone
- (858) 534-8817
- Fax
- (858) 534-9410
- NPI assigned
- Jul 28, 2016
- 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 | PSY26510 | CA | Primary |
Addresses
Primary practice location
3252 Holiday CT
La Jolla, CA 92037-0027
Mailing address
3252 Holiday CT
La Jolla, CA 92037-0027
Phone (858) 534-8817
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY26510 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1469664000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1469664000000",
"number": "1174076954",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3252 HOLIDAY CT",
"city": "LA JOLLA",
"state": "CA",
"postal_code": "920370027",
"telephone_number": "858-534-8817",
"fax_number": "858-534-9410"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3252 HOLIDAY CT",
"city": "LA JOLLA",
"state": "CA",
"postal_code": "920370027",
"telephone_number": "858-534-8817",
"fax_number": "858-534-9410"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCKENNA",
"first_name": "BENJAMIN",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-07-28",
"last_updated": "2016-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY26510",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Jolla, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 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.