Individual provider Active NPI

Diane Cynn, PSY.D.

  • Clinical Psychologist
  • Brookline, MA
National Provider Identifier
1467533216
Registry record updated Jan 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
8641 Issued in MA
Practice address
1693 Beacon St Ste 1F
Brookline, MA 02445-4467
Phone
(617) 935-1655
NPI assigned
Oct 18, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2022

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 8641 MA Primary

Addresses

Primary practice location

1693 Beacon St Ste 1F
Brookline, MA 02445-4467

Mailing address

20 Cheshire St
Jamaica Plain, MA 02130-2223
Phone (617) 935-1655

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
I20070604000659 MA Practitioner - Clinical Psychologist 6800994526 Practice locations: Brookline, MA

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Paula Koren, Licsw LLC PastSince May 23, 2018 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641513600000",
    "number": "1467533216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 CHESHIRE ST",
            "city": "JAMAICA PLAIN",
            "state": "MA",
            "postal_code": "021302223",
            "telephone_number": "617-935-1655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1693 BEACON ST STE 1F",
            "city": "BROOKLINE",
            "state": "MA",
            "postal_code": "024454467",
            "telephone_number": "617-935-1655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CYNN",
        "first_name": "DIANE",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-18",
        "last_updated": "2022-01-07",
        "certification_date": "2022-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "8641",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookline, MA

Sources for this page

Verify at the official NPI Registry.