Provider Demographics
NPI:1881670578
Name:DANSER, DONALD B (PHD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:B
Last Name:DANSER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 WASHINGTON ST
Mailing Address - Street 2:SUITE 2401
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-4084
Mailing Address - Country:US
Mailing Address - Phone:315-788-3332
Mailing Address - Fax:315-788-4584
Practice Address - Street 1:531 WASHINGTON ST
Practice Address - Street 2:SUITE 2401
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-4084
Practice Address - Country:US
Practice Address - Phone:315-788-3332
Practice Address - Fax:315-788-4584
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009513103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDA53558BMedicare ID - Type Unspecified
NYR56940Medicare UPIN