Kristopher J Olsen, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY0004859 Issued in FL

Practice address

6767 N Wickham Rd
Suite 306
Melbourne, FL 32940-2031

Phone

(321) 751-1925

Fax

(321) 751-9261

NPI assigned

Jan 11, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Psychology Associates of Brevard PLCGroup PAC ID 9638078025, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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.

• Psychology Associates of Brevard PLC

  • Clinical Psychologist
  • Melbourne, FL
  • NPI 1922200278
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315785600000",
    "number": "1083764492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6767 N WICKHAM RD",
            "address_2": "SUITE 306",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329402031",
            "telephone_number": "321-751-1925",
            "fax_number": "321-751-9261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6767 N WICKHAM RD",
            "address_2": "SUITE 306",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329402031",
            "telephone_number": "321-751-1925",
            "fax_number": "321-751-9261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSEN",
        "first_name": "KRISTOPHER",
        "middle_name": "J",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-11",
        "last_updated": "2011-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY0004859",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carlos Mario Oliveira, MD
• Claudia Delia Oliver
• Kimberly Oliver
• Marion L Oliver, PHARMACIST
• Kevin Olivieri
• Sara Olson
• Jay Edward Olsson, DO PROF ASSOCIATIONN
• Om Urology LLC
• Jurry Om, FNP
• Omni Healthcare, Inc

• Clinical Psychologist in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Clinical Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2011; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.