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General NPI Number Information
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NPI Number | 1073681425
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Entity Type | Individual
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Provider Name | MELINDA EILEEN KULISH PH.D.
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Gender | Female
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Dates
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Enumeration Date | 12/02/2006
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Last Update Date | 12/19/2011
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Provider Practice Location Address
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Address Line | 1679 MASSACHUSETTS AVE
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City | CAMBRIDGE
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State | MA
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Zip | 02138-1877
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Country | US
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Telephone | 617-492-2841
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Fax | 617-492-1079
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Provider Business Mailing Address
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Address Line | 7 FAIRVIEW AVE
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City | ARLINGTON
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State | MA
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Zip | 02474-1215
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Country | US
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Telephone | 781-643-4969
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 7822
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 7822
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License Number State | MA
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