Active NPI
Kennon M. S. McDonough, PSY.D.
- Psychologist
- San Mateo, CA
National Provider Identifier
1225326051
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- CA PSY 23179
- Practice address
- 221 N San Mateo Dr
San Mateo, CA 94401-2608 - Phone
- (650) 344-1248
- NPI assigned
- Jul 13, 2011
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | CA PSY 23179 | CA | Primary |
Addresses
Primary practice location
221 N San Mateo Dr
San Mateo, CA 94401-2608
Mailing address
221 N San Mateo Dr
San Mateo, CA 94401-2608
Phone (650) 344-1248
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Oct 1, 2015 through Oct 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CA PSY 23179 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1310515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1310515200000",
"number": "1225326051",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "221 N SAN MATEO DR",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944012608",
"telephone_number": "650-344-1248"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "221 N SAN MATEO DR",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944012608",
"telephone_number": "650-344-1248"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCDONOUGH",
"first_name": "KENNON",
"middle_name": "M. S.",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-07-13",
"last_updated": "2011-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "CA PSY 23179",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Mateo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.