Provider Demographics
NPI:1255489498
Name:BROOKS, LIZA (PHD)
Entity Type:Individual
Prefix:DR
First Name:LIZA
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:1101 BEACON ST
Mailing Address - Street 2:SUITE 2 E
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5587
Mailing Address - Country:US
Mailing Address - Phone:617-730-5676
Mailing Address - Fax:617-730-3755
Practice Address - Street 1:1101 BEACON ST
Practice Address - Street 2:SUITE 2 E
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5587
Practice Address - Country:US
Practice Address - Phone:617-730-5676
Practice Address - Fax:617-730-3755
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2763103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW50513Medicare ID - Type Unspecified