Dale E Dillavou, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

3613 Issued in MA

Practice address

545 Concord Ave
Suite 20
Cambridge, MA 02138

Phone

(617) 499-9977

NPI assigned

Jan 29, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2014 through Jan 1, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1841336757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 NORTH HANCOCK ST",
            "city": "LEXINGTON",
            "state": "MA",
            "postal_code": "024203406",
            "telephone_number": "781-862-2576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 CONCORD AVE",
            "address_2": "SUITE 20",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "02138",
            "telephone_number": "617-499-9977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DILLAVOU",
        "first_name": "DALE",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MA",
            "license": "3613",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN ACADEMY OF HEALT",
            "identifier": "3310",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATL REG OF HEALTH CARE P",
            "identifier": "34261",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samuel Diedhiou, M.ED
• Maud Dieudonne
• Julia Mabel Digenan
• Eavan Elizabeth Digiovanni, DPT, PT
• Frances Dilks, NP
• Emmeline A Diller, M.D.
• Charlotte Dillon
• Dimagi, Inc.
• Yelizaveta Dimant
• Julia Carr Dimartino, LICSW

• Psychologist in Cambridge, MA
• Providers in Cambridge, MA by specialty
• Psychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.

Verify at the official NPI Registry.