Provider Demographics
NPI:1093315483
Name:BISTRAS, GINTA
Entity Type:Individual
Prefix:
First Name:GINTA
Middle Name:
Last Name:BISTRAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 OLD CANAL DR
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-2730
Mailing Address - Country:US
Mailing Address - Phone:978-452-5155
Mailing Address - Fax:
Practice Address - Street 1:22 OLD CANAL DR
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-2730
Practice Address - Country:US
Practice Address - Phone:978-452-5155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)