Kathleen M Condon, PSY.D

Primary specialty

PsychologistTaxonomy code 103T00000X

License

24048 Issued in CA

Practice address

1080 Emeline Ave
Santa Cruz, CA 95060-1966

Phone

(831) 454-4100

NPI assigned

Feb 20, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

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 and National Provider Directory roles.

• County of Santa Cruz

  • Clinic/Center
  • Santa Cruz, CA
  • NPI 1659315430
  Medicare reassignment
• County of Santa Cruz

  • Federally Qualified Health Center (FQHC)
  • Watsonville, CA
  • NPI 1770709149
  Medicare reassignment
• County of Santa Cruz

  • Federally Qualified Health Center (FQHC)
  • Santa Cruz, CA
  • NPI 1578680310
  NPD
• Puentes Al Sur

  • Adult Mental Health Clinic/Center
  • Watsonville, CA
  • NPI 1992849012
  NPD (past)
• Health West, Inc.

  • Federally Qualified Health Center (FQHC)
  • Pocatello, ID
  • NPI 1740143882
  NPD (past)

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

{
    "created_epoch": "1203465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693267200000",
    "number": "1053580308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1080 EMELINE AVENUE",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950601976",
            "telephone_number": "831-454-4872",
            "fax_number": "831-454-4296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1080 EMELINE AVE",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950601966",
            "telephone_number": "831-454-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONDON",
        "first_name": "KATHLEEN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "PSY.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-20",
        "last_updated": "2023-08-29",
        "certification_date": "2023-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "ID",
            "license": "PSY-202418",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "24048",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PSYCHOLOGIST LICENSE NUMBER",
            "identifier": "24048",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI ORGANIZATION LEGAL ENTITY",
            "identifier": "1659315430",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70042F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Communi-Qi Acupuncture
• Community Bridges
• Community Connection
• Megan Tanuhandaru Comparan
• Raquel Sunny Concha, B.A.,OTS
• Tracy Anne Cone, L.AC.
• Connect Primary Care Santa Cruz
• Donald Paul Connolly I, D.D.S.
• Jordan Console
• Brittney Contreras

• Psychologist in Santa Cruz, CA
• Providers in Santa Cruz, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 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.