Provider Demographics
NPI:1750318762
Name:KAPUST, LISSA ROBINS (MSW)
Entity Type:Individual
Prefix:MR
First Name:LISSA
Middle Name:ROBINS
Last Name:KAPUST
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Gender:F
Credentials:MSW
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Mailing Address - Street 1:330 BROOKLINE AVENUE
Mailing Address - Street 2:BEHAVIORAL NEUROLOGY K2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:617-667-5150
Mailing Address - Fax:617-667-7981
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:BEHAVIORAL NEUROLOGY K2
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-667-5150
Practice Address - Fax:617-667-7981
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MA1006911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical