Active NPI
Kierra Benton, LCSW
- Clinical Social Worker
- Modesto, CA
National Provider Identifier
1720560394
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 110018
- Practice address
- 800 Scenic Dr
Modesto, CA 95350-6131 - Phone
- (209) 525-6201
- NPI assigned
- Aug 30, 2018
- Last updated
- Sep 5, 2023
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 83346 | CA | |
| Clinical Social Worker | 1041C0700X | 110018 | CA | Primary |
Addresses
Primary practice location
800 Scenic Dr
Modesto, CA 95350-6131
Mailing address
800 Scenic Dr
Modesto, CA 95350-6131
Phone (209) 525-6070
Other practice location 1
9412 Big Horn Blvd
Elk Grove, CA 95758-1101
Phone (772) 584-6252
Other practice location 2
5445 Laurel Hills Dr
Sacramento, CA 95841-3105
Phone (772) 584-6252
Other practice location 3
670 Placerville Dr Ste 2
Placerville, CA 95667-4200
Phone (530) 644-2412
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 83346 | CA | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1535587200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693872000000",
"number": "1720560394",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 SCENIC DR",
"city": "MODESTO",
"state": "CA",
"postal_code": "953506131",
"telephone_number": "209-525-6070"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 SCENIC DR",
"city": "MODESTO",
"state": "CA",
"postal_code": "953506131",
"telephone_number": "209-525-6201"
}
],
"practiceLocations": [
{
"address_1": "9412 Big Horn Blvd",
"address_purpose": "LOCATION",
"city": "Elk Grove",
"state": "CA",
"postal_code": "957581101",
"country_code": "US",
"telephone_number": "772-584-6252",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "5445 Laurel Hills Dr",
"address_purpose": "LOCATION",
"city": "Sacramento",
"state": "CA",
"postal_code": "958413105",
"country_code": "US",
"telephone_number": "772-584-6252",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "670 Placerville Dr Ste 2",
"address_purpose": "LOCATION",
"city": "Placerville",
"state": "CA",
"postal_code": "956674200",
"country_code": "US",
"telephone_number": "530-644-2412",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BENTON",
"first_name": "KIERRA",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-08-30",
"last_updated": "2023-09-05",
"certification_date": "2023-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "CA",
"license": "83346",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "110018",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 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.