Individual
MARTHA M VIBBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1 BOSTON MEDICAL CTR PL, BOSTON, MA 02118-2908
(617) 414-5245
(617) 414-5520
Mailing address
960 MASSACHUSETTS AVE, FL 2, BOSTON, MA 02118
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6147
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110023740A
—
MA
Enumeration date
07/27/2006
Last updated
12/12/2023
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