Elisheva Dan, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

7240 Issued in MA

Practice address

1415 Beacon St
Suite #304
Brookline, MA 02446-4816

Phone

(617) 738-0780

Fax

(617) 566-9314

NPI assigned

Jan 23, 2007

Sex

Female

Sole proprietor

Yes

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

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 1, 2018 through Jul 1, 2028

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": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320105600000",
    "number": "1063566339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 BEACON ST",
            "address_2": "SUITE #304",
            "city": "BROOKLINE",
            "state": "MA",
            "postal_code": "024464816",
            "telephone_number": "617-738-0780",
            "fax_number": "617-566-9314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 BEACON ST",
            "address_2": "SUITE #304",
            "city": "BROOKLINE",
            "state": "MA",
            "postal_code": "024464816",
            "telephone_number": "617-738-0780",
            "fax_number": "617-566-9314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAN",
        "first_name": "ELISHEVA",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-23",
        "last_updated": "2011-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "7240",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "696",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Dahmann, M.ED, NCC
• Tracey Lorraine Daley, MD
• Roxanne Dallaire, DPT
• Suzanne Daly-Creatore, OTR/L
• Kate Daly
• Dana J Fryer Nutrition LLC
• Dana K. Fugelso, M.D.
• Daniel Beck, Licsw, LLC
• Linda Daniels, PSY.D.
• Darel Moss D.D.S. PC

• Clinical Psychologist in Brookline, MA
• Providers in Brookline, MA by specialty
• Clinical Psychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.