Active NPI
Kevin Edward Carroll, PH.D.
- Clinical Neuropsychologist
- San Francisco, CA
National Provider Identifier
1396960670
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- 15690
- Practice address
- 450 Stanyan St
400E, Rehabilitation
San Francisco, CA 94117-1079 - Phone
- (415) 750-5805
- NPI assigned
- Apr 13, 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 | 15690 | CA | Primary |
Addresses
Primary practice location
450 Stanyan St
400E, Rehabilitation
San Francisco, CA 94117-1079
Mailing address
41 Bruce CT
Pleasant Hill, CA 94523-3601
Phone (415) 750-5805
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 |
|---|---|---|---|
| 15690 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176422400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1396960670",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "41 BRUCE CT",
"city": "PLEASANT HILL",
"state": "CA",
"postal_code": "945233601",
"telephone_number": "415-750-5805"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "450 STANYAN ST",
"address_2": "400E, REHABILITATION",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941171079",
"telephone_number": "415-750-5805"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARROLL",
"first_name": "KEVIN",
"middle_name": "EDWARD",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "CA",
"license": "15690",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Francisco, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.