Provider Demographics
NPI:1700371200
Name:KENENI, ANA M (LCSW)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:M
Last Name:KENENI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 MARTIN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-8651
Mailing Address - Country:US
Mailing Address - Phone:707-428-4198
Mailing Address - Fax:
Practice Address - Street 1:2420 MARTIN RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-8651
Practice Address - Country:US
Practice Address - Phone:202-826-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
CA1197801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2536Medicaid
CA9668OtherPACIFIC CLINICS
CA1484OtherNORTHERN VALLEY INDIAN HEALTH