Provider Demographics
NPI:1073591954
Name:KISTNER, OLIVIA LOWELL (MSW)
Entity Type:Individual
Prefix:MS
First Name:OLIVIA
Middle Name:LOWELL
Last Name:KISTNER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-2724
Mailing Address - Country:US
Mailing Address - Phone:781-453-9082
Mailing Address - Fax:781-453-9082
Practice Address - Street 1:400 HILLSIDE AVE
Practice Address - Street 2:HAML CLINICAL ASSOCIATES
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-1263
Practice Address - Country:US
Practice Address - Phone:781-453-9082
Practice Address - Fax:781-453-9082
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA105570-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health