Provider Demographics
NPI:1679639769
Name:KLEINMAN, ELISSA COREY (MD)
Entity Type:Individual
Prefix:DR
First Name:ELISSA
Middle Name:COREY
Last Name:KLEINMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 BEALS ST
Mailing Address - Street 2:#2
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-6011
Mailing Address - Country:US
Mailing Address - Phone:617-734-3354
Mailing Address - Fax:
Practice Address - Street 1:127 MOUNT AUBURN ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5732
Practice Address - Country:US
Practice Address - Phone:617-734-3354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA533792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ06468OtherBLUE CROSS BLUE SHIELD
MAJ06468OtherBLUE CROSS BLUE SHIELD