Provider Demographics
NPI:1104965847
Name:KHALSA, MANJIT KAUR (EDD)
Entity type:Individual
Prefix:DR
First Name:MANJIT
Middle Name:KAUR
Last Name:KHALSA
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 VILLAGE ST
Mailing Address - Street 2:
Mailing Address - City:MILLIS
Mailing Address - State:MA
Mailing Address - Zip Code:02054-1730
Mailing Address - Country:US
Mailing Address - Phone:508-376-8104
Mailing Address - Fax:
Practice Address - Street 1:166 VILLAGE ST
Practice Address - Street 2:
Practice Address - City:MILLIS
Practice Address - State:MA
Practice Address - Zip Code:02054-1730
Practice Address - Country:US
Practice Address - Phone:508-376-8104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1715103TC1900X
MA3142103T00000X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3142OtherSTATE LICENSE
MA3142OtherSTATE LICENSE