Provider Demographics
NPI:1174823074
Name:CENTER FOR COGNITIVE WELLNESS PC
Entity Type:Organization
Organization Name:CENTER FOR COGNITIVE WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MALISSA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:617-913-9030
Mailing Address - Street 1:37 STACEY CIR
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-1648
Mailing Address - Country:US
Mailing Address - Phone:617-913-9030
Mailing Address - Fax:
Practice Address - Street 1:15 NEW ENGLAND EXECUTIVE PARK
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-5202
Practice Address - Country:US
Practice Address - Phone:617-913-9030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8932103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty