Provider Demographics
NPI:1003837097
Name:MENDELSOHN, MICHAELA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAELA
Middle Name:
Last Name:MENDELSOHN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 MASSACHUSETTS AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1836
Mailing Address - Country:US
Mailing Address - Phone:617-429-3523
Mailing Address - Fax:
Practice Address - Street 1:1675 MASSACHUSETTS AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1836
Practice Address - Country:US
Practice Address - Phone:617-429-3523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8211103TC0700X, 103T00000X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy