Provider Demographics
NPI:1780814723
Name:DY-HOLLINS, MARISELA ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:MARISELA
Middle Name:ELIZABETH
Last Name:DY-HOLLINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARISELA
Other - Middle Name:ELIZABETH
Other - Last Name:DY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:375 BOYLSTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-6007
Mailing Address - Country:US
Mailing Address - Phone:857-307-0869
Mailing Address - Fax:617-726-2019
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-726-3642
Practice Address - Fax:617-726-0192
Is Sole Proprietor?:No
Enumeration Date:2009-07-24
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2622142084N0402X, 2084N0402X
CAA1148612084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology