Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 7104 | MA |
N | 103T00000X | Psychologist | 7104 | MA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 7104 | MA |
Y | 103G00000X | Clinical Psychologist | 7104 | MA |
Y | 103TC0700X | Clinical Psychologist | 7104 | MA |
N | 103TH0100X | Health Service | 7104 | MA |
N | 103TP2701X | Group Psychotherapist | 7104 | MA |
NPI | 1114031903 |
---|---|
Provider Name | Lisa R. Strauss |
First Address | Brookline, MA 02446-3885 |
Second Address | Brookline, MA 02446-3885 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 02/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0525936 | (05) | MA |
W05630 | BLUE CROSS (01) | MA |