Active NPI
Alexander Jason Bennett, PH.D.
- Psychologist
- Berkeley, CA
National Provider Identifier
1558004127
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 34206
- Practice address
- 2222 Bancroft Way
Berkeley, CA 94720-4301 - Phone
- (510) 725-7215
- NPI assigned
- Apr 20, 2022
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 34206 | CA | Primary |
Addresses
Primary practice location
2222 Bancroft Way
Berkeley, CA 94720-4301
Mailing address
2222 Bancroft Way
Berkeley, CA 94720-4301
Phone (510) 725-7215
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34206 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1650412800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1699228800000",
"number": "1558004127",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2222 BANCROFT WAY",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947204301",
"telephone_number": "510-725-7215"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2222 BANCROFT WAY",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947204301",
"telephone_number": "510-725-7215"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENNETT",
"first_name": "ALEXANDER",
"middle_name": "JASON",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-04-20",
"last_updated": "2023-11-06",
"certification_date": "2023-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "34206",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berkeley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.