Benjamin Fennimore, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

L11039 Issued in OR

Practice address

1787 State St
Salem, OR 97301-4342

Phone

(503) 566-2132

NPI assigned

Sep 3, 2014

Last updated

Jul 5, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Family Building Blocks

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Salem, OR
  • NPI 1255964730
  NPD Authorized official
• Pure Life Counseling, LLC

  • Clinical Social Worker
  • Salem, OR
  • NPI 1982489951
  NPD Authorized official
• Lutheran Community Services Northwest

  dba Lcsnw

  • Community/Behavioral Health Agency
  • McMinnville, OR
  • NPI 1255542106
  NPD (past)

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

{
    "created_epoch": "1409702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688515200000",
    "number": "1881094324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2860 WINTER ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973023155",
            "telephone_number": "503-428-2948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1787 STATE ST",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973014342",
            "telephone_number": "503-566-2132"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2425 Lancaster Dr NE",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "OR",
            "postal_code": "973051220",
            "country_code": "US",
            "telephone_number": "503-566-2132",
            "fax_number": "503-566-2134",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "494 State St Ste 270",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "OR",
            "postal_code": "973013647",
            "country_code": "US",
            "telephone_number": "503-583-2121",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FENNIMORE",
        "first_name": "BENJAMIN",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-09-03",
        "last_updated": "2023-07-05",
        "certification_date": "2023-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L11039",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1417567983",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1255964730",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Conor Joseph Feeney
• Cynthia Jane Fegles, MA, LMFT, CADCI
• Michelle Elizabeth Feldman, D.O.
• Catherine Mary Emilia Feltz, LMT
• Emma Felzien, MD
• Adam Garrett Fenske, PSYD
• Melanie J Ferder
• Alina Ferguson
• Lynzie Joe Ferguson, LMSW
• Patrick James Ferrari

• Clinical Social Worker in Salem, OR
• Providers in Salem, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 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.

Verify at the official NPI Registry.