Active NPI
Kenji Takeda
- Clinical Psychologist
- Brooklyn, NY
National Provider Identifier
1225671985
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 023480
- Practice address
- 68 35TH St Unit 4
Brooklyn, NY 11232-2211 - Phone
- (718) 622-4058
- NPI assigned
- Oct 24, 2019
- 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 | 023480 | NY | Primary |
Addresses
Primary practice location
68 35TH St Unit 4
Brooklyn, NY 11232-2211
Mailing address
68 35TH St Unit 4
Brooklyn, NY 11232-2211
Phone (718) 622-4058
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | kenji@smallbrooklyn.com | Direct |
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 |
|---|---|---|---|
| 023480 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1571875200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571875200000",
"number": "1225671985",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "68 35TH ST UNIT 4",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112322211",
"telephone_number": "718-622-4058"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "68 35TH ST UNIT 4",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112322211",
"telephone_number": "718-622-4058"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAKEDA",
"first_name": "KENJI",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-10-24",
"last_updated": "2019-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "023480",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "kenji@smallbrooklyn.com",
"affiliation": "N",
"endpointDescription": "Encrypted Email Address",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "68 35th St Unit 4",
"city": "Brooklyn",
"state": "NY",
"country_code": "US",
"postal_code": "112322211",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.