Dr Diana Hearst Ikeda, PHD is a
Psychologist - Cognitive & Behavioral based in Duxbury, Massachusetts. Dr Diana Hearst Ikeda is licensed to practice in Massachusetts (license number 6917) and her current practice location is
20 Tremont St, Suite 12 A, Duxbury, Massachusetts. She can be reached at her office (for appointments etc.) via phone at
(781) 934-6390.
NPI number for Dr Diana Hearst Ikeda is 1124146717 and her current mailing address is Po Box 2628, Duxbury, Massachusetts. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1124146717.
Healthcare Provider's Profile
| Full Name | Dr Diana Hearst Ikeda |
|---|
| Gender | Female |
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| Speciality | Psychologist - Cognitive & Behavioral |
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| Location | 20 Tremont St, Duxbury, Massachusetts |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1124146717
- Provider Enumeration Date: 03/26/2007
- Last Update Date: 12/13/2013
Medical Identifiers
Medical identifiers for Dr Diana Hearst Ikeda such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1124146717 | NPI | - | NPPES |
| W05211 | Medicaid | MA | |
| W05611 | Other | MA | BLUE CROSS BLUE SHIELD |
| 407109 | Other | MA | TUFTS BEHAVIORAL HEALTH |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 6917 (Massachusetts) | Secondary |
| 101YM0800X | Counselor - Mental Health | 6917 (Massachusetts) | Secondary |
| 103T00000X | Psychologist | 6917 (Massachusetts) | Secondary |
| 103TA0400X | Psychologist - Addiction (substance Use Disorder) | 6917 (Massachusetts) | Secondary |
| 103TA0700X | Psychologist - Adult Development & Aging | 6917 (Massachusetts) | Secondary |
| 103TB0200X | Psychologist - Cognitive & Behavioral | 6917 (Massachusetts) | Primary |
| 103TC0700X | Psychologist - Clinical | 6917 (Massachusetts) | Secondary |
| 103TC1900X | Psychologist - Counseling | 6917 (Massachusetts) | Secondary |
| 103TC2200X | Psychologist - Clinical Child & Adolescent | 6917 (Massachusetts) | Secondary |
| 103TF0000X | Psychologist - Family | 6917 (Massachusetts) | Secondary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Diana Hearst Ikeda is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Diana Hearst Ikeda, PHD
Po Box 2628,
Duxbury, MA 02331-2628
Ph: (781) 934-6390 | Dr Diana Hearst Ikeda, PHD
20 Tremont St, Suite 12 A,
Duxbury, MA 02332-5310
Ph: (781) 934-6390 |
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