Active NPI
Kenneth John Breniman, LCSW, RYT
- Clinical Social Worker
- Oakland, CA
National Provider Identifier
1457651689
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 22958
- Practice address
- 1511 Jefferson St
Townhouse 9
Oakland, CA 94612-1402 - Phone
- (510) 388-2884
- NPI assigned
- Oct 21, 2010
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 22958 | CA | Primary |
| Respiratory/Developmental/Rehabilitative Specialist/Technologist | 225500000X | 25705 YOGA ALLIANCE | CA |
Addresses
Primary practice location
1511 Jefferson St
Townhouse 9
Oakland, CA 94612-1402
Mailing address
1511 Jefferson St
Townhouse 9
Oakland, CA 94612-1402
Phone (510) 388-2884
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 |
|---|---|---|---|
| 22958 | CA | MD | Clinical Social Worker |
| 25705 YOGA ALLIANCE | CA | MD | Respiratory/Developmental/Rehabilitative Specialist/Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1287619200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1287619200000",
"number": "1457651689",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1511 JEFFERSON ST",
"address_2": "TOWNHOUSE 9",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946121402",
"telephone_number": "510-388-2884"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1511 JEFFERSON ST",
"address_2": "TOWNHOUSE 9",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946121402",
"telephone_number": "510-388-2884"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRENIMAN",
"first_name": "KENNETH",
"middle_name": "JOHN",
"name_prefix": "Mr.",
"credential": "LCSW, RYT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-10-21",
"last_updated": "2010-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "22958",
"primary": true
},
{
"code": "225500000X",
"taxonomy_group": "",
"desc": "Specialist/Technologist",
"state": "CA",
"license": "25705 YOGA ALLIANCE",
"primary": false
}
],
"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 Oct 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.