Active NPI
Brett Elias Kociol, PSY.D.
- Clinical Psychologist
- San Jose, CA
National Provider Identifier
1770891277
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY26382
- Practice address
- 3507 Palmilla Dr Unit 2118
San Jose, CA 95134-2266 - Phone
- (408) 691-5498
- NPI assigned
- Sep 17, 2010
- 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 | PSY26382 | CA | Primary |
Addresses
Primary practice location
3507 Palmilla Dr Unit 2118
San Jose, CA 95134-2266
Mailing address
3507 Palmilla Dr Unit 2118
San Jose, CA 95134-2266
Phone (408) 691-5498
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 1, 2022 through Oct 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY26382 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1284681600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407715200000",
"number": "1770891277",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3507 PALMILLA DR UNIT 2118",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951342266",
"telephone_number": "408-691-5498"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3507 PALMILLA DR UNIT 2118",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951342266",
"telephone_number": "408-691-5498"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOCIOL",
"first_name": "BRETT",
"middle_name": "ELIAS",
"name_prefix": "Mr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-09-17",
"last_updated": "2014-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY26382",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.