Koenraad Van Braeckel, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY31225 Issued in CA

Practice address

3665 Kearny Villa Rd
San Diego, CA 92123-1953

Phone

(858) 966-5817

NPI assigned

May 5, 2014

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1399248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786492800000",
    "number": "1750791307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3020 CHILDRENS WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234223",
            "telephone_number": "858-966-5817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3665 KEARNY VILLA RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921231953",
            "telephone_number": "858-966-5817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN BRAECKEL",
        "first_name": "KOENRAAD",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-05",
        "last_updated": "2026-08-12",
        "certification_date": "2026-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY31225",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IA",
            "license": "072303",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vamsi K Aribindi MD Medical Corporation
• Mariana Van Antwerp
• Michael Gabriel Van Bebber
• Kai Rond Van Bodegom-Smith, L.AC.
• Ann Van Bourg, PA
• Jonathan Van de Leuv, MD
• Yaroll Van de Vin
• Erik Francis Van Den Akker
• Ellis Petronella Van Den Boogaard, MS ED., MA
• Theodorus B.M. Van Den Helder, M.D.

• Psychologist in San Diego, CA
• Providers in San Diego, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.