Provider Demographics
NPI:1821288614
Name:KRAFT, MALISSA L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MALISSA
Middle Name:L
Last Name:KRAFT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:781-572-0021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist