Individual
ALIYAH BANISTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
420 MAIN ST STE 15, WALPOLE, MA 02081-3753
(508) 660-1666
(508) 660-1667
Mailing address
420 MAIN ST STE 15, WALPOLE, MA 02081-3753
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
120042
MA
Other
Enumeration date
12/09/2016
Last updated
05/17/2017
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