Daniel Anderson, PHD
Individual provider Active NPI Psychologist · Midwest City, OK
NPI 1265028856 · NPPES record last updated Oct 30, 2024
Key facts
- NPI
- 1265028856
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 1465 (OK)
- Practice address
- 1212 S Air Depot Blvd Ste 9
Midwest City, OK 73110-4860 - Phone
- (405) 455-6868
- NPI assigned
- Dec 17, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Oklahoma State University College of Osteopathic Medicine, 2019
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1493 Cambridge St
Cambridge, MA 02139-1099
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250923004003 | MA | Practitioner - Clinical Psychologist | 1052816857 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1465 | OK | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cambridge Public Health Commission | Current |
Accepting new patients | |
| Cambridge Public Health Commission | Current |
Accepting new patients |
Locations
1493 Cambridge St
Cambridge, MA 02139
Phone (617) 665-1185
350 Main St
Ste 31
Malden, MA 02148
Phone (781) 397-6583
Interoperability endpoints
- danderson124993@direct.challiance.masshiway.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | |||
| Behavior Analyst | 103K00000X | |||
| Psychologist | 103T00000X | 1465 | OK | Yes |
Addresses
Primary practice location
1212 S Air Depot Blvd Ste 9
Midwest City, OK 73110-4860
Mailing address
1212 S Air Depot Blvd Ste 9
Midwest City, OK 73110-4860
Phone (405) 455-6868
Other names
- Daniel Blake Anderson
Other providers in Midwest City, OK
- Samson Mulu Ambaw
- Grace Ayerkai Amedzro
- Khabbab Amin
- Muhammad Amin
- Bethany Jo Anderson
- Joel W Anderson III
- Kimberly Michelle Anderson
- Michael Terry Anderson
- Quincy Anderson
- Anesthesia Specialists of Oklahoma, LLC
All providers in Midwest City, OK · Psychologist in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 30, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.