Healthcare Provider Details

I. General information

NPI: 1104053933
Provider Name (Legal Business Name): STELLA BITRAN JOHNSON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STELLA BITRAN PHD

II. Dates (important events)

Enumeration Date: 06/19/2009
Last Update Date: 02/12/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 ADAMS STREET
NEWTON MA
02460
US

IV. Provider business mailing address

89 NEEDHAM STREET APT 2342
NEWTON MA
02461
US

V. Phone/Fax

Practice location:
  • Phone: 617-390-3083
  • Fax: 617-527-2412
Mailing address:
  • Phone: 617-390-3086
  • Fax: 617-874-6879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number9180
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number9180
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: