MEDICARE: DONALD B. DANSER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	009513	NY

General Provider Information

NPI Number	:	1881670578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD B. DANSER PH.D.

Provider Business Mailing Address
First Line	:	531 WASHINGTON ST
Second Line	:	SUITE 2401
City	:	WATERTOWN
State	:	NY
Zip	:	13601-4084
Country	:	US
Telephone Number	:	315-788-3332
Fax Number	:	315-788-4584

Provider Business Practice Location Address
First Line	:	531 WASHINGTON ST
Second Line	:	SUITE 2401
City	:	WATERTOWN
State	:	NY
Zip	:	13601-4084
Country	:	US
Telephone Number	:	315-788-3332
Fax Number	:	315-788-4584

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	07/08/2007

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