Individual
DR. KIMBERLY BISTIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
294 WASHINGTON ST., SUITE 415, BOSTON, MA 02108-4639
(617) 571-6688
Mailing address
328 COPELAND ST.., 3F, QUINCY, MA 02169-4030
(617) 571-6688
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
7480
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1859986
—
MA
01
—
W05968
BCBS MA
MA
Enumeration date
11/03/2005
Last updated
06/22/2015
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