Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 8267 | MA |
N | 103T00000X | Psychologist | 8267 | MA |
Y | 103G00000X | Clinical Psychologist | 8267 | MA |
Y | 103TC0700X | Clinical Psychologist | 8267 | MA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1093031320 |
---|---|
Provider Name | Dr. Cori Cieurzo Liptak |
First Address | Norfolk, MA 02056-4001 |
Second Address | Boston, MA 02215-5418 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2010 |
Last Update Date | 17/03/2018 |