Provider Demographics
NPI:1437673548
Name:COMMISSARIAT, PERSIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:PERSIS
Middle Name:
Last Name:COMMISSARIAT
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 1:1 JOSLIN PLACE
Mailing Address - Street 2:RM 362
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5306
Mailing Address - Country:US
Mailing Address - Phone:617-732-2603
Mailing Address - Fax:
Practice Address - Street 1:1 JOSLIN PL
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-732-2603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10656103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty