Healthcare Provider Details

I. General information

NPI: 1457278566
Provider Name (Legal Business Name): MDB PSYCHOTHERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 MASSACHUSETTS AVE UNIT 282
LEXINGTON MA
02420-2032
US

IV. Provider business mailing address

1661 MASSACHUSETTS AVE UNIT 282
LEXINGTON MA
02420-2032
US

V. Phone/Fax

Practice location:
  • Phone: 617-903-8947
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL DI BIANCA
Title or Position: LICENSED COUNSELING PSYCHOLOGIST
Credential: PHD
Phone: 617-903-8947