Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 3142 | MA |
N | 103T00000X | Psychologist | 3142 | MA |
N | 103TC1900X | Counseling Psychologist | 1715 | NM |
N | 103TP2701X | Group Psychotherapist | 3142 | MA |
NPI | 1104965847 |
---|---|
Provider Name | Dr. Manjit Kaur Khalsa |
First Address | Millis, MA 02054-1730 |
Second Address | Millis, MA 02054-1730 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3142 | STATE LICENSE (01) | MA |