Provider Demographics
NPI:1740680693
Name:KHALSA, HANSMUKH (MS)
Entity type:Individual
Prefix:
First Name:HANSMUKH
Middle Name:
Last Name:KHALSA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 SEA STREET
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169
Mailing Address - Country:US
Mailing Address - Phone:508-244-2369
Mailing Address - Fax:
Practice Address - Street 1:32 COMMON ST
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-2803
Practice Address - Country:US
Practice Address - Phone:508-668-3223
Practice Address - Fax:508-668-0755
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-28
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health