Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Kevin Joseph Nissen, PHD

Individual provider Psychologist · NPI 1245093616

Dr. Kevin Joseph Nissen, PHD is a Clinical Psychologist in Northport, New York. Qualified in 2023, 3 years ago. Practices with North Shore-Lij Medical PC, a 6,350-clinician group, accepts Medicare assignment and offers telehealth.

Years since qualifying
3
In the registry since
2024
What do these letters mean?
PHD — Doctor of Philosophy
A research doctorate. In healthcare it usually sits alongside a clinical licence.

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Practice location Address checks out

79 Middleville Rd
Northport, NY 11768-2200
Phone: (631) 261-4400
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychologist (primary) Taxonomy 103T00000X

Record details

NPI number1245093616
Entity typeIndividual (Type 1)
GenderMale
Credentials PHD
Sole proprietorNo
NPI enumeratedJanuary 30, 2024
Last updated in NPPESJanuary 30, 2024
Certification dateJanuary 30, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL PSYCHOLOGIST
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice North Shore-Lij Medical Pc — 6350 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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