Active NPI
Kenneth Mathisen, PH.D.
- Clinical Psychologist
- Hillsborough, NJ
National Provider Identifier
1497882815
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 35SI00199600
- Practice address
- 407 Omni Dr
Hillsborough, NJ 08844-4527 - Phone
- (908) 359-0760
- Fax
- (908) 359-5356
- NPI assigned
- Feb 27, 2007
- Last updated
- Jul 8, 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 Psychologist | 103TC0700X | 35SI00199600 | NJ | Primary |
Addresses
Primary practice location
407 Omni Dr
Hillsborough, NJ 08844-4527
Mailing address
407 Omni Dr
Hillsborough, NJ 08844-4527
Phone (908) 359-0760
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050421000125 | NJ | Practitioner - Clinical Psychologist | 8527006410 | Practice locations: Hillsborough, NJ |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35SI00199600 | NJ | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1497882815",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "407 OMNI DR",
"city": "HILLSBOROUGH",
"state": "NJ",
"postal_code": "088444527",
"telephone_number": "908-359-0760",
"fax_number": "908-359-5356"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "407 OMNI DR",
"city": "HILLSBOROUGH",
"state": "NJ",
"postal_code": "088444527",
"telephone_number": "908-359-0760",
"fax_number": "908-359-5356"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATHISEN",
"first_name": "KENNETH",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NJ",
"license": "35SI00199600",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hillsborough, NJ
- Diana Martinez
- Susan N Martinez, LCSW
- Daniel George Marulli, D.D.S.
- Matheny School and Hospital (Matheny Medical and Educational Center)
- Matheny School and Hospital (Hillsborough Day Program)
- Manjiri Bhate Mathur, D.M.D.
- Robert Edward Matros, D.C.
- Mayuri Medical Center Limited Liability Company
- John W Mazellan, LCSW
- Dana Mazza, LSW
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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.