Individual provider Active NPI

Denise M Renye

  • Psychologist
  • Fairfax, CA
National Provider Identifier
1407049349
Registry record updated Aug 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PSY28096 Issued in CA
Practice address
769 Center Blvd # 144
Fairfax, CA 94930-1764
Phone
(415) 286-5014
NPI assigned
Aug 23, 2007
Last updated
Aug 21, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Psychologist 103T00000X PSY28096 CA Primary
Clinical Psychologist 103TC0700X PSY28096 CA

Addresses

Primary practice location

769 Center Blvd # 144
Fairfax, CA 94930-1764

Mailing address

769 Center Blvd # 144
Fairfax, CA 94930-1764
Phone (415) 286-5014

Other practice location 1

1801 Vicente St
San Francisco, CA 94116-2923
Phone (415) 681-3211

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

LicenseStateTypeSpecialty
PSY28096CAMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Whole Person Psychology, Apc Psychologist CurrentSince Feb 1, 2024 Accepting new patients

Locations

769 Center Blvd
Fairfax, CA 94930
Phone (415) 286-5014

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1187827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724198400000",
    "number": "1407049349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "769 CENTER BLVD # 144",
            "city": "FAIRFAX",
            "state": "CA",
            "postal_code": "949301764",
            "telephone_number": "415-286-5014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "769 CENTER BLVD # 144",
            "city": "FAIRFAX",
            "state": "CA",
            "postal_code": "949301764",
            "telephone_number": "415-286-5014"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1801 Vicente St",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "941162923",
            "country_code": "US",
            "telephone_number": "415-681-3211",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RENYE",
        "first_name": "DENISE",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-23",
        "last_updated": "2024-08-21",
        "certification_date": "2024-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY28096",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY28096",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfax, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2024; 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.