DR. KEVIN JOSEPH NISSEN PH.D.
NPI 1245093616
Psychologist in Northport, NY

Active since January 30, 2024PECOS EnrolledAccepts Medicare Assignment
79 MIDDLEVILLE RD, NORTHPORT, NY 11768(631) 261-4400 Get Directions Write a Review

NPPES record last updated: January 30, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dr. Kevin Joseph Nissen Ph.d. NPPES

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

DR. KEVIN JOSEPH NISSEN PH.D. (NPI 1245093616) is an individual psychologist in Northport, New York and active in the NPI registry since January 2024. He is enrolled in Medicare PECOS and is a graduate of Other (2023).

NPPES Registry Identity

NPI1245093616
Entity TypeIndividualMale
Primary Taxonomy103T00000X
Provider Legal NameDR. KEVIN JOSEPH NISSENCredential: PH.D.
Location Address79 MIDDLEVILLE RDNorthport, NY 11768-2200
Mailing AddressPo Box 34Holtsville, NY 11742-0034 · (631) 578-9526
Sole ProprietorNo
Medical School CMSOtherGraduated 2023
Enumeration DateJanuary 30, 2024
NPPES CertifiedJanuary 30, 2024
NPI 1245093616 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
Definition
A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.
79 MIDDLEVILLE RD, Northport, NY 11768

Accepted Insurance

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Dr. Kevin Joseph Nissen Ph.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6103351572
PECOS Enrollment IDI20241121002713
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

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

Social Worker
79 MIDDLEVILLE RD
NORTHPORT, NY 11768
Social Worker (Clinical)
79 MIDDLEVILLE RD
NORTHPORT, NY 11768
Anesthesiology
79 MIDDLEVILLE RD
NORTHPORT, NY 11768
General Acute Care Hospital
79 MIDDLEVILLE RD
NORTHPORT, NY 11768
Social Worker
79 MIDDLEVILLE RD
NORTHPORT, NY 11768
Nurse Practitioner (Psychiatric/Mental Health)
79 MIDDLEVILLE RD
NORTHPORT, NY 11768
Pharmacist
79 MIDDLEVILLE RD
NORTHPORT, NY 11768
Occupational Therapist
79 MIDDLEVILLE RD
NORTHPORT, NY 11768

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 Kevin Nissen's NPI number?

The NPI number for Kevin Nissen is 1245093616. It was assigned to this individual provider in the NPPES registry on January 30, 2024.

Where is Kevin Nissen located?

Kevin Nissen practices at 79 Middleville Rd, Northport, NY 11768. The listed phone number is (631) 261-4400.

What is Kevin Nissen's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Is Kevin Nissen enrolled in Medicare?

Yes. Kevin Nissen is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Kevin Nissen accept?

Health plans from Providence Health Plan list Kevin Nissen as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kevin Nissen was last updated on January 30, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.