Provider Demographics
NPI:1568542322
Name:MESHOULAM, URIEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:URIEL
Middle Name:
Last Name:MESHOULAM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-2117
Mailing Address - Country:US
Mailing Address - Phone:617-491-3801
Mailing Address - Fax:
Practice Address - Street 1:15 CENTRE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-2117
Practice Address - Country:US
Practice Address - Phone:617-491-3801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2109103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MABCBSOtherW02274
MABCBSOtherW02274