Peninsula Counseling and Consulting Inc Ryan Gardner

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

PENINSULA COUNSELING AND CONSULTING INC RYAN GARDNER

Practice address

3099 Telegraph Ave
Berkeley, CA 94705-2035

Phone

(650) 644-4454

Fax

(650) 644-4456

NPI assigned

Aug 21, 2020

Organization subpart

No

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

Authorized official

Name

Ryan Gardner, MBA, LCSWNPI 1477796225

Title

Executive Director

Phone

(510) 778-4494

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ryan Gardner

  • Clinical Social Worker
  • Fresno, CA
  • NPI 1477796225
  NPD Authorized official

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

{
    "created_epoch": "1597968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629158400000",
    "number": "1265044168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1259 EL CAMINO REAL # 136",
            "city": "MENLO PARK",
            "state": "CA",
            "postal_code": "940254208",
            "telephone_number": "650-644-4454",
            "fax_number": "650-644-4456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3099 TELEGRAPH AVE",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947052035",
            "telephone_number": "650-644-4454",
            "fax_number": "650-644-4456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA COUNSELING AND CONSULTING INC RYAN GARDNER",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-21",
        "last_updated": "2021-08-17",
        "certification_date": "2021-08-17",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "510-778-4494",
        "authorized_official_credential": "MBA, LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.simplepractice.com",
            "affiliation": "N",
            "endpointDescription": "EHR",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3099 Telegraph Ave",
            "city": "Berkeley",
            "state": "CA",
            "country_code": "US",
            "postal_code": "947052035",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jordan Gabriel Pelot, M.A., LMFT
• Rachael Arline Peltz, PH.D.
• Diana Pena, PH.D.
• Rafael Pena
• Penelope S.Yip D.D.S., Inc.
• Nicole Cassandra Penrod, AMFT
• Maria Elida Pentrack
• Laurie Ellen Peoples
• Maria Pepe, L.AC.
• Erik Peper, PHD, BCB

• Clinical Social Worker in Berkeley, CA
• Providers in Berkeley, 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 Aug 17, 2021; 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.