Provider Demographics
NPI:1730914276
Name:HOLLISTER, MAEVE
Entity type:Individual
Prefix:
First Name:MAEVE
Middle Name:
Last Name:HOLLISTER
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 1:14 IRVING ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-3833
Mailing Address - Country:US
Mailing Address - Phone:781-956-7705
Mailing Address - Fax:
Practice Address - Street 1:17 INNERBELT RD
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-4418
Practice Address - Country:US
Practice Address - Phone:617-629-6790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health