Healthcare Provider Details

I. General information

NPI: 1790699411
Provider Name (Legal Business Name): BIBULD PSYCHOTHERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 BEACON ST
BROOKLINE MA
02446-3282
US

IV. Provider business mailing address

1330 BEACON ST STE 327
BROOKLINE MA
02446-3203
US

V. Phone/Fax

Practice location:
  • Phone: 857-246-9539
  • Fax:
Mailing address:
  • Phone: 857-246-9539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. LISA FRANCINE BIBULD
Title or Position: PSYCHOLOGIST
Credential: PSYD
Phone: 857-246-9539