Kevin Doyle Brock, PH.D.
Individual provider Active NPI Clinical Psychologist · Los Altos, CA
NPI 1487985503 · NPPES record last updated Jan 29, 2010
Key facts
- NPI
- 1487985503
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- PSY 23229 (CA)
- Practice address
- 881 Fremont Ave Ste B8
Los Altos, CA 94024-5637 - Phone
- (650) 380-0991
- NPI assigned
- Jan 29, 2010
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 23229 | CA | MD | Clinical Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY 23229 | CA | Yes |
Addresses
Primary practice location
881 Fremont Ave Ste B8
Los Altos, CA 94024-5637
Mailing address
1433 Ravenswood Dr
Los Altos, CA 94024-5845
Phone (650) 380-0991
Other providers in Los Altos, CA
- Judith Anne Boore
- Lourdes Bella Lareza Bourdon
- Breathe Holistic Health, Inc.
- Theresa Dagondon Brinkman
- Raziel Elohima-Rizzo Brisbane
- Ryan Canaan Broms
- Mara Lenox Bronstein
- Lloyd Brown
- Peter Watson Brown
- Sarah M Brown
All providers in Los Altos, CA · Clinical Psychologist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 29, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.