Active NPI
Kenneth Mallon
- Mental Health Counselor
- San Jose, CA
National Provider Identifier
1205505302
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 116516
- Practice address
- 950 S Bascom Ave Ste 2005
San Jose, CA 95128-3538 - Phone
- (650) 487-0604
- NPI assigned
- Sep 10, 2021
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 116516 | CA | Primary |
Addresses
Primary practice location
950 S Bascom Ave Ste 2005
San Jose, CA 95128-3538
Mailing address
1210 S Bascom Ave Ste 114
San Jose, CA 95128-3535
Phone (650) 487-0604
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 116516 | CA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1631232000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1677974400000",
"number": "1205505302",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1210 S BASCOM AVE STE 114",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951283535",
"telephone_number": "650-487-0604"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "950 S BASCOM AVE STE 2005",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951283538",
"telephone_number": "650-487-0604"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALLON",
"first_name": "KENNETH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-09-10",
"last_updated": "2023-03-05",
"certification_date": "2023-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "116516",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.