Active NPI
Kiana M Clerkley
- Clinical Social Worker
- San Jose, CA
National Provider Identifier
1528524162
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 111026
- Practice address
- 1356 Ridder Park Dr
San Jose, CA 95131-2313 - Phone
- (669) 304-7585
- NPI assigned
- Feb 19, 2019
- Last updated
- Nov 3, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 111026 | CA | Primary |
| Community Health Worker | 172V00000X | NU | ||
| Behavior Analyst | 103K00000X | CA |
Addresses
Primary practice location
1356 Ridder Park Dr
San Jose, CA 95131-2313
Mailing address
2125 Cryer PL
Hayward, CA 94545-3064
Phone (510) 393-4055
Other practice location 1
1100 Lincoln Ave Ste 108
Napa, CA 94558-4908
Phone (707) 255-3719
Other practice location 2
1025 Atlantic Ave
Alameda, CA 94501-1189
Phone (510) 328-7178
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9140860054 | Other | CA | AETNA |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1550534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667433600000",
"number": "1528524162",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2125 CRYER PL",
"city": "HAYWARD",
"state": "CA",
"postal_code": "945453064",
"telephone_number": "510-393-4055"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1356 RIDDER PARK DR",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951312313",
"telephone_number": "669-304-7585"
}
],
"practiceLocations": [
{
"address_1": "1100 Lincoln Ave Ste 108",
"address_purpose": "LOCATION",
"city": "Napa",
"state": "CA",
"postal_code": "945584908",
"country_code": "US",
"telephone_number": "707-255-3719",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1025 Atlantic Ave",
"address_purpose": "LOCATION",
"city": "Alameda",
"state": "CA",
"postal_code": "945011189",
"country_code": "US",
"telephone_number": "510-328-7178",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CLERKLEY",
"first_name": "KIANA",
"middle_name": "M",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-02-19",
"last_updated": "2022-11-03",
"certification_date": "2022-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "111026",
"primary": true
},
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "CA",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "9140860054",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 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.