Provider Demographics
NPI:1043735913
Name:MARIA BISBAS
Entity Type:Organization
Organization Name:MARIA BISBAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BISBAS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:617-678-1203
Mailing Address - Street 1:38 COLONIAL AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02460-1215
Mailing Address - Country:US
Mailing Address - Phone:617-678-1203
Mailing Address - Fax:
Practice Address - Street 1:38 COLONIAL AVE
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02460-1215
Practice Address - Country:US
Practice Address - Phone:617-678-1203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-11
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10148101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty