Provider Demographics
NPI:1114031903
Name:STRAUSS, LISA R (PHD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:R
Last Name:STRAUSS
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 1:1180 BEACON ST
Mailing Address - Street 2:SUITE 5C
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-3885
Mailing Address - Country:US
Mailing Address - Phone:617-731-4837
Mailing Address - Fax:617-731-1110
Practice Address - Street 1:1180 BEACON ST
Practice Address - Street 2:SUITE 5C
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3885
Practice Address - Country:US
Practice Address - Phone:617-731-4837
Practice Address - Fax:617-731-1110
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7104103TC0700X, 103TB0200X, 103TP2701X, 103TH0100X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0525936Medicaid
MAW05630OtherBLUE CROSS
MAW50138Medicare ID - Type UnspecifiedMEDICARE NHIC