Provider Demographics
NPI:1053460139
Name:SHILLER, VIRGINIA MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:MARIE
Last Name:SHILLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 EVERIT ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-1335
Mailing Address - Country:US
Mailing Address - Phone:203-787-2182
Mailing Address - Fax:203-865-1673
Practice Address - Street 1:147 BISHOP ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3717
Practice Address - Country:US
Practice Address - Phone:203-776-3681
Practice Address - Fax:203-776-3681
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1236103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist