Individual
LISA F. BIBULD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
1 BOSTON MEDICAL CENTER PLACE, BOSTON, MA 02118
(617) 414-5245
(617) 414-5520
Mailing address
801 ALBANY STREET, FLOOR GROUND, BOSTON, MA 02119
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
11300
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110165671A
—
MA
Enumeration date
05/15/2007
Last updated
02/15/2022
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