Active NPI
Kenneth S. Benau, PH.D.
- Clinical Psychologist
- Kensington, CA
National Provider Identifier
1336353689
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY11684
- Practice address
- 376 Colusa Ave Ste 2
Kensington, CA 94707-1213 - Phone
- (510) 525-3702
- Fax
- (510) 763-8501
- NPI assigned
- May 9, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | PSY11684 | CA | Primary |
Addresses
Primary practice location
376 Colusa Ave Ste 2
Kensington, CA 94707-1213
Mailing address
1315 Holman Rd
Oakland, CA 94610-2542
Phone (510) 763-8501
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Apr 1, 2016 through Apr 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11684 | CA | MD | Addiction (Substance Use Disorder) Counselor |
| 1234 | CA | MD | Addiction (Substance Use Disorder) Counselor |
| PSY11684 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1336353689",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1315 HOLMAN RD",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946102542",
"telephone_number": "510-763-8501",
"fax_number": "510-763-8501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "376 COLUSA AVE STE 2",
"city": "KENSINGTON",
"state": "CA",
"postal_code": "947071213",
"telephone_number": "510-525-3702",
"fax_number": "510-763-8501"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENAU",
"first_name": "KENNETH",
"middle_name": "S.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY11684",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kensington, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.