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KENNETH MALLON
NPI 1205505302
Counselor - Mental Health in San Jose, CA

Active since September 10, 2021Opted out of Medicare · through Jan 1, 2028
950 S BASCOM AVE STE 2005, SAN JOSE, CA 95128(650) 487-0604 Get Directions Write a Review

NPPES record last updated: March 5, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Mar 5, 2023, Sep 10, 2021 (2 updates tracked since 2021).

About Kenneth Mallon NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KENNETH MALLON (NPI 1205505302) is an individual mental health provider in San Jose, California, licensed in California (116516) and active in the NPI registry since September 2021. He has opted out of Medicare through January 1, 2028.

NPPES Registry Identity

NPI1205505302
Entity TypeIndividualMale
Primary Taxonomy101YM0800X
Provider Legal NameKENNETH MALLON
Location Address950 S BASCOM AVE STE 2005San Jose, CA 95128-3538
Mailing Address1210 S Bascom Ave Ste 114San Jose, CA 95128-3535 · (650) 487-0604
Phone(650) 487-0604
Sole ProprietorNo
Enumeration DateSeptember 10, 2021
Last NPPES UpdateMarch 5, 20232 updates tracked since enumeration
NPPES CertifiedMarch 5, 2023
✔ NPI 1205505302 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
License✔ Licensed in CA · 116516
950 S BASCOM AVE STE 2005, San Jose, CA 95128
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Kenneth Mallon has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 1, 2024 through January 1, 2028.

Opt-Out Effective DateJanuary 1, 2024
Opt-Out In Effect ThroughJanuary 1, 2028Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CONCORDIS BEHAVIORAL HEALTH, A PROFESSIONAL NURSING ORGANIZATION
Nurse Practitioner (Psychiatric/Mental Health)
950 S BASCOM AVE STE 2005
SAN JOSE, CA 95128
Santa Clara County (510) 859-8082

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kenneth Mallon's NPI number?

The NPI number for Kenneth Mallon is 1205505302. It was assigned to this individual provider in the NPPES registry on September 10, 2021.

Where is Kenneth Mallon located?

Kenneth Mallon practices at 950 S Bascom Ave Ste 2005, San Jose, CA 95128. The listed phone number is (650) 487-0604.

What is Kenneth Mallon's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Kenneth Mallon enrolled in Medicare?

No. Kenneth Mallon has opted out of Medicare through January 1, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Kenneth Mallon was last updated on March 5, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.