Active NPI
David Gottesman, PH.D.
- Clinical Psychologist
- Wellesley, MA
National Provider Identifier
1205929924
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2727
- Practice address
- One Washington Street
Suite 305
Wellesley, MA 02481 - Phone
- (877) 499-2625
- Fax
- (617) 244-3480
- NPI assigned
- Oct 2, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2727 | MA | Primary |
| Clinical Psychologist | 103TC0700X | PS00678 | RI |
Addresses
Primary practice location
One Washington Street
Suite 305
Wellesley, MA 02481
Mailing address
One Washington Street
Suite 305
Wellesley, MA 02481
Phone (877) 499-2625
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| WO2820 | Other | MA | BLUE CROSS/BLUE SHIELD MA |
| 020064 | Other | MA | VALUE-OPTIONS |
Medicare participation
Medicare enrollment files- 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
- Opted out of Medicare
- Yes, effective Dec 1, 2013 through Dec 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS00678 | RI | MD | Clinical Psychologist |
| 2727 | MA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1331510400000",
"number": "1205929924",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "ONE WASHINGTON STREET",
"address_2": "SUITE 305",
"city": "WELLESLEY",
"state": "MA",
"postal_code": "02481",
"telephone_number": "877-499-2625",
"fax_number": "617-244-3480"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "ONE WASHINGTON STREET",
"address_2": "SUITE 305",
"city": "WELLESLEY",
"state": "MA",
"postal_code": "02481",
"telephone_number": "877-499-2625",
"fax_number": "617-244-3480"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOTTESMAN",
"first_name": "DAVID",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-02",
"last_updated": "2012-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "2727",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "RI",
"license": "PS00678",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS/BLUE SHIELD MA",
"identifier": "WO2820",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE-OPTIONS",
"identifier": "020064",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wellesley, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2012; 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.