Provider Demographics
NPI:1568549327
Name:DANA, RICHARD S (EDD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:S
Last Name:DANA
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WALNUT ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WELLESLEY HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02481-2104
Mailing Address - Country:US
Mailing Address - Phone:781-235-9696
Mailing Address - Fax:781-235-9697
Practice Address - Street 1:20 WALNUT ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WELLESLEY HILLS
Practice Address - State:MA
Practice Address - Zip Code:02481-2104
Practice Address - Country:US
Practice Address - Phone:781-235-9696
Practice Address - Fax:781-235-9697
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3230103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW03323OtherBCBS