Healthcare Provider Details

I. General information

NPI: 1003837097
Provider Name (Legal Business Name): MICHAELA MENDELSOHN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 MASSACHUSETTS AVE 2ND FLOOR
CAMBRIDGE MA
02138-1836
US

IV. Provider business mailing address

1675 MASSACHUSETTS AVE 2ND FLOOR
CAMBRIDGE MA
02138-1836
US

V. Phone/Fax

Practice location:
  • Phone: 617-429-3523
  • Fax:
Mailing address:
  • Phone: 617-429-3523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8211
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number8211
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number8211
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: