DIANNE ELISE PSY 12309 - NPI 1356290241 - Psychologist in Oakland, CA

Q: What is Dianne Elise's NPI number?

The NPI number for Dianne Elise is 1356290241. It was assigned to this individual provider in the NPPES registry on January 24, 2026.

Q: What is Dianne Elise's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Q: Is Dianne Elise enrolled in Medicare?

No. Dianne Elise has opted out of Medicare through September 30, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

Q: When was this NPI record last updated?

The NPPES record for Dianne Elise was last updated on January 24, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

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About Dianne Elise Psy 12309 NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DIANNE ELISE PSY 12309 (NPI 1356290241) is an individual clinical provider in Oakland, California, licensed in California (PSY12309) and active in the NPI registry since January 2026. She has opted out of Medicare through September 30, 2027.

NPPES Registry Identity

NPI1356290241

Entity TypeIndividualFemale

Primary Taxonomy103TC0700X

Provider Legal NameDIANNE ELISECredential: PSY 12309

Location Address5349 COLLEGE AVEOakland, CA 94618-1416

Mailing Address5349 College AveOakland, CA 94618-1416 · (510) 653-5575

Phone(510) 653-5575

Sole ProprietorYes

Enumeration DateJanuary 24, 2026

NPPES CertifiedJanuary 24, 2026

✔ NPI 1356290241 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

License✔ Licensed in CA · PSY12309

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

5349 COLLEGE AVE, Oakland, CA 94618

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dianne Elise Psy 12309 has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from September 30, 2023 through September 30, 2027.

Opt-Out Effective DateSeptember 30, 2023

Opt-Out In Effect ThroughSeptember 30, 2027Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ROBERT DOUGLAS LARSON PSYD

Psychologist (Clinical)