Active NPI
Kinshasa A Bennett, PHD
- Clinical Psychologist
- San Francisco, CA
National Provider Identifier
1669637757
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY26517
- Practice address
- 1801 Vicente St
San Francisco, CA 94116-2923 - Phone
- (415) 681-3211
- NPI assigned
- Jul 28, 2008
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | |||
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Clinical Psychologist | 103TC0700X | PSY26517 | CA | Primary |
Addresses
Primary practice location
1801 Vicente St
San Francisco, CA 94116-2923
Mailing address
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY26517 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1217203200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723680000000",
"number": "1669637757",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1801 VICENTE ST",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941162923",
"telephone_number": "415-681-3211"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1801 VICENTE ST",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941162923",
"telephone_number": "415-681-3211"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENNETT",
"first_name": "KINSHASA",
"middle_name": "A",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-07-28",
"last_updated": "2024-08-15",
"certification_date": "2024-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY26517",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Francisco, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 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.