Active NPI
Samuel Kwame Dance, PSYD, MBA
- Psychologist
- Boston, MA
National Provider Identifier
1376062133
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY10000099
- Practice address
- 1290 Tremont St
.
Boston, MA 02120-3432 - Phone
- (617) 989-3009
- NPI assigned
- Sep 13, 2017
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY.0006989 | CO | |
| Psychologist | 103T00000X | PSY10000099 | MA | Primary |
Addresses
Primary practice location
1290 Tremont St
.
Boston, MA 02120-3432
Mailing address
1290 Tremont St
Roxbury, MA 02120-3432
Phone (617) 989-3009
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Business Administration
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY.0006989 | CO | MD | Psychologist |
| PSY10000099 | MA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1505260800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1774310400000",
"number": "1376062133",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1290 TREMONT ST",
"city": "ROXBURY",
"state": "MA",
"postal_code": "021203432",
"telephone_number": "617-989-3009"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1290 TREMONT ST",
"address_2": ".",
"city": "BOSTON",
"state": "MA",
"postal_code": "021203432",
"telephone_number": "617-989-3009"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DANCE",
"first_name": "SAMUEL",
"middle_name": "KWAME",
"name_prefix": "Dr.",
"credential": "PSYD, MBA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-09-13",
"last_updated": "2026-03-24",
"certification_date": "2026-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CO",
"license": "PSY.0006989",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MA",
"license": "PSY10000099",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.