Provider Demographics
NPI:1811936180
Name:MIHALKO, JASON EVAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:EVAN
Last Name:MIHALKO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 MASSACHUSETTS AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-3828
Mailing Address - Country:US
Mailing Address - Phone:617-491-0326
Mailing Address - Fax:
Practice Address - Street 1:1208 MASSACHUSETTS AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-3828
Practice Address - Country:US
Practice Address - Phone:617-491-0326
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8576103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical