Provider Demographics
NPI:1649373077
Name:HOLLISTER, ROBIN C (PSYD)
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:C
Last Name:HOLLISTER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
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Mailing Address - Street 1:57 DONIZETTI ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-4840
Mailing Address - Country:US
Mailing Address - Phone:617-694-0083
Mailing Address - Fax:781-239-0234
Practice Address - Street 1:572 WASHINGTON ST
Practice Address - Street 2:2ND FLOOR, SUITE 4
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-6418
Practice Address - Country:US
Practice Address - Phone:781-892-3000
Practice Address - Fax:781-239-0234
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA7559103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAWO5963OtherBCBS
MA500555OtherVALUE OPTIONS
MA500555OtherVALUE OPTIONS