Active NPI
Eliza Christine McKenna, LCSW
- Clinical Social Worker
- Oakland, CA
National Provider Identifier
1396079125
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 25851
- Practice address
- 2202 Rosedale Ave
Oakland, CA 94601-4326 - Phone
- (510) 495-5440
- NPI assigned
- Sep 26, 2009
- Sex
- Female
- 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 Social Worker | 1041C0700X | 25851 | CA | Primary |
Addresses
Primary practice location
2202 Rosedale Ave
Oakland, CA 94601-4326
Mailing address
2202 Rosedale Ave
Oakland, CA 94601-4326
Phone (510) 495-5440
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25851 | CA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Access Multi-Specialty Medical Clinic, Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
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- Burlingame, CA
- NPI 1245365782
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1253923200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654300800000",
"number": "1396079125",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2202 ROSEDALE AVE",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946014326",
"telephone_number": "510-495-5440",
"fax_number": "415-775-7730"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2202 ROSEDALE AVE",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946014326",
"telephone_number": "510-495-5440"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCKENNA",
"first_name": "ELIZA",
"middle_name": "CHRISTINE",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-09-26",
"last_updated": "2022-06-04",
"certification_date": "2022-05-25",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "25851",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 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.