Yajaira Marilyn Kennison, PSYD, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

79259 Issued in CA

Practice address

10775 Pioneer TRL Ste 215
Truckee, CA 96161-0234

Phone

(415) 424-4266

Fax

(415) 520-6633

NPI assigned

Nov 19, 2008

Last updated

Apr 28, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mariana's Services

  • Adult Mental Health Clinic/Center
  • Sacramento, CA
  • NPI 1487524781
  NPD Authorized official
• Cognitive Care Solutions Group Inc

  • Cognitive & Behavioral Psychologist
  • Santa Ana, CA
  • NPI 1548614183
  NPD
• Grow Healthcare Group PC

  • Mental Health Counselor
  • San Jose, CA
  • NPI 1154994846

  Psychologist

  NPD
• Blue Moon Senior Counseling of California LLC

  • Clinical Social Worker
  • Plainfield, IL
  • NPI 1447678990
  NPD
• Telehealth Services USA

  dba Hazel Health Services

  • Pediatrics Physician
  • Truckee, CA
  • NPI 1275035263

  Clinical

  NPD (past)

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

{
    "created_epoch": "1227052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682640000000",
    "number": "1700031648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8300 ESTERS BLVD STE 900",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750632233",
            "telephone_number": "415-424-4266",
            "fax_number": "415-520-6633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10775 PIONEER TRL STE 215",
            "city": "TRUCKEE",
            "state": "CA",
            "postal_code": "961610234",
            "telephone_number": "415-424-4266",
            "fax_number": "415-520-6633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNISON",
        "first_name": "YAJAIRA",
        "middle_name": "MARILYN",
        "name_prefix": "Dr.",
        "credential": "PSYD, LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-19",
        "last_updated": "2023-04-28",
        "certification_date": "2023-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "31592",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "79259",
            "primary": true
        },
        {
            "code": "225C00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Counselor",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1700031648",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dianne C Kamenetsky, MD
• Myron Kamenetsky, M.D.
• Kelley Gorham Kasper
• Ryan Keaton
• Syndi Keats, M.D.
• Hannah Maria Kerry
• Adrian J Khaw, MD
• Thomas Kim, MD
• Rachel Kirbyrost
• Paige Parker Kirscht, MSN, APRN, FNP-C

• Clinical Social Worker in Truckee, CA
• Providers in Truckee, 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 Apr 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.