MEDICARE: INTEGRATED ASSESSMENT SERVICES, LLC

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	7822	MA
2	103G00000X	Clinical Neuropsychologist	7822	MA

General Provider Information

NPI Number	:	1053747659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED ASSESSMENT SERVICES, LLC

Provider Business Mailing Address
First Line	:	1753 MASSACHUSETTS AVE
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02140-2231
Country	:	US
Telephone Number	:	617-661-1100
Fax Number	:	617-661-1101

Provider Business Practice Location Address
First Line	:	1753 MASSACHUSETTS AVE
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02140-2231
Country	:	US
Telephone Number	:	617-661-1100
Fax Number	:	617-661-1101

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MELINDA EILEEN KULISH
Credential	:	PH.D.
Telephone Number	:	617-661-1100

Provider Enumeration Date	:	09/16/2013
Last Update Date	:	09/16/2013

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Directions to “INTEGRATED ASSESSMENT SERVICES, LLC ” Practice Location

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