Provider Demographics
NPI:1134499247
Name:STILLER, LISA PAULETTE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:PAULETTE
Last Name:STILLER
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 1:1751 CLOVERFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-4007
Mailing Address - Country:US
Mailing Address - Phone:310-450-0650
Mailing Address - Fax:
Practice Address - Street 1:1751 CLOVERFIELD BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-4007
Practice Address - Country:US
Practice Address - Phone:310-450-0650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13304103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist