Provider Demographics
NPI:1134135734
Name:LISS, HARVEY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:
Last Name:LISS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 MAIN ST
Mailing Address - Street 2:SUITE 38
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-3908
Mailing Address - Country:US
Mailing Address - Phone:802-257-1062
Mailing Address - Fax:802-257-4399
Practice Address - Street 1:67 MAIN ST
Practice Address - Street 2:SUITE 38
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-3908
Practice Address - Country:US
Practice Address - Phone:802-257-1062
Practice Address - Fax:802-257-4399
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT048-0000220103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical