Individual
DR. LAURA M DISTEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
300 LONGWOOD AVE, BOSTON, MA 02115-5724
(617) 919-7492
Mailing address
300 LONGWOOD AVE, BOSTON, MA 02115-5724
(617) 355-6000
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
11936
MA
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
Other
Enumeration date
07/27/2022
Last updated
10/18/2022
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