Active NPI
Kenneth R. Pelletier, PHD, MD(HC)
- Clinical Neuropsychologist
- Alamo, CA
National Provider Identifier
1184748014
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- PSY4631
- Practice address
- 5 Country Oak LN
Alamo, CA 94507-2854 - Phone
- (925) 932-7074
- Fax
- (925) 838-3007
- NPI assigned
- Mar 17, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | PSY4631 | CA | Primary |
Addresses
Primary practice location
5 Country Oak LN
Alamo, CA 94507-2854
Mailing address
5 Country Oak LN
Alamo, CA 94507-2854
Phone (925) 932-7074
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY4631 | CA | MD | Clinical Neuropsychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174089600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1762214400000",
"number": "1184748014",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 COUNTRY OAK LN",
"city": "ALAMO",
"state": "CA",
"postal_code": "945072854",
"telephone_number": "925-932-7074",
"fax_number": "925-838-3007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 COUNTRY OAK LN",
"city": "ALAMO",
"state": "CA",
"postal_code": "945072854",
"telephone_number": "925-932-7074",
"fax_number": "925-838-3007"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PELLETIER",
"first_name": "KENNETH",
"middle_name": "R.",
"name_prefix": "Dr.",
"credential": "PHD, MD(HC)",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-17",
"last_updated": "2025-11-04",
"certification_date": "2025-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "CA",
"license": "PSY4631",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Alamo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.