Peter Phoenix Chinnici III, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCS14720 Issued in CA

Practice address

820 Las Gallinas Ave
Kaiser Permanente Dept of Psychiatry
San Rafael, CA 94903-3410

Phone

(415) 444-3027

Fax

(415) 444-3019

NPI assigned

Jan 4, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619024288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "332 BAYVIEW ST",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949014934",
            "telephone_number": "415-457-8340",
            "fax_number": "415-444-3019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 LAS GALLINAS AVE",
            "address_2": "KAISER PERMANENTE DEPT OF PSYCHIATRY",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949033410",
            "telephone_number": "415-444-3027",
            "fax_number": "415-444-3019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHINNICI",
        "first_name": "PETER",
        "middle_name": "PHOENIX",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS14720",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Child Therapy Institute of Marin
• Child Therapy Institute of Marin
• Child Therapy Institute of Marin
• Clyde Childress Jr.
• Miranda Chin, PHARM.D.
• Nancy Chirinos
• Mercy Hung Chiu, PT
• Monica Chiu, M.D.
• Tina Tinlan Chiu, MD
• Eunkyo Cho, DDS

• Clinical Social Worker in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.