Provider Demographics
NPI:1073681425
Name:KULISH, MELINDA EILEEN (PHD)
Entity type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:EILEEN
Last Name:KULISH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-1215
Mailing Address - Country:US
Mailing Address - Phone:781-643-4969
Mailing Address - Fax:
Practice Address - Street 1:1679 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1877
Practice Address - Country:US
Practice Address - Phone:617-492-2841
Practice Address - Fax:617-492-1079
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7822103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW06157OtherBCBS OF MA INDEMNITY