Provider Demographics
NPI:1457651689
Name:BRENIMAN, KENNETH JOHN (LCSW, RYT)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:JOHN
Last Name:BRENIMAN
Suffix:
Gender:M
Credentials:LCSW, RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 JEFFERSON ST
Mailing Address - Street 2:TOWNHOUSE 9
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-1402
Mailing Address - Country:US
Mailing Address - Phone:510-388-2884
Mailing Address - Fax:
Practice Address - Street 1:1511 JEFFERSON ST
Practice Address - Street 2:TOWNHOUSE 9
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1402
Practice Address - Country:US
Practice Address - Phone:510-388-2884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA229581041C0700X
CA25705 YOGA ALLIANCE225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist