Individual provider Active NPI

David W. Fentress, ED.D.

  • Clinical Psychologist
  • New Bedford, MA
National Provider Identifier
1275540510
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
MA 3487 Issued in MA
Practice address
50 N 2ND St
New Bedford, MA 02740-6249
Phone
(508) 993-1377
Fax
(508) 999-7795
NPI assigned
Aug 1, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X MA 3487 MA Primary

Addresses

Primary practice location

50 N 2ND St
New Bedford, MA 02740-6249

Mailing address

50 N 2ND St
New Bedford, MA 02740-6249
Phone (508) 993-1377

Other identifiers 1

IdentifierTypeStateIssuer
0514179MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121031000351 MA Practitioner - Clinical Psychologist 1153571054 Practice locations: South Dartmouth, MA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Harvard Medical School, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1157 Russells Mills Rd
South Dartmouth, MA 02748-1015
Phone (508) 971-2550

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
MA 3487MAMDClinical Psychologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1275540510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 N 2ND ST",
            "city": "NEW BEDFORD",
            "state": "MA",
            "postal_code": "027406249",
            "telephone_number": "508-993-1377",
            "fax_number": "508-999-7795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 N 2ND ST",
            "city": "NEW BEDFORD",
            "state": "MA",
            "postal_code": "027406249",
            "telephone_number": "508-993-1377",
            "fax_number": "508-999-7795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FENTRESS",
        "first_name": "DAVID",
        "middle_name": "W.",
        "name_prefix": "Dr.",
        "credential": "ED.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "MA 3487",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0514179",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New Bedford, MA

Sources for this page

Verify at the official NPI Registry.