Provider Demographics
NPI:1619003043
Name:KAUFMAN, MILISSA L (MD, PHD)
Entity Type:Individual
Prefix:
First Name:MILISSA
Middle Name:L
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MCLEAN HOSPITAL
Mailing Address - Street 2:115 MILL STREET
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478
Mailing Address - Country:US
Mailing Address - Phone:617-726-2066
Mailing Address - Fax:
Practice Address - Street 1:MCLEAN HOSPITAL
Practice Address - Street 2:115 MILL STREET
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478
Practice Address - Country:US
Practice Address - Phone:617-726-2066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAL-2217872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry