Individual
DR. LAWRENCE M KISTLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
105 CHESTNUT ST STE 31, NEEDHAM, MA 02492-2520
(781) 455-6336
Mailing address
105 CHESTNUT ST, NEEDHAM, MA 02492-2520
(781) 455-6336
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2691
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101288
MANAGED HEALTH NETWORK
MA
01
—
138864
MAGELLAN
MA
01
—
W02857
BLUE CROSS BLUE SHIELD
MA
Enumeration date
08/29/2005
Last updated
07/08/2007
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