Provider Demographics
NPI:1336507656
Name:HALLER, CHIARA SIMONE (PHD, LP, HSP)
Entity Type:Individual
Prefix:DR
First Name:CHIARA
Middle Name:SIMONE
Last Name:HALLER
Suffix:
Gender:F
Credentials:PHD, LP, HSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 UPLAND RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-2717
Mailing Address - Country:US
Mailing Address - Phone:617-902-0567
Mailing Address - Fax:
Practice Address - Street 1:5 UPLAND RD
Practice Address - Street 2:SUITE 2
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-2717
Practice Address - Country:US
Practice Address - Phone:617-902-0567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-01
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9919103G00000X, 103T00000X, 103TC0700X, 103TC1900X, 103TH0100X, 103TP2701X, 103TR0400X
NY020907103G00000X, 103T00000X, 103TC0700X, 103TB0200X, 103TP2701X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral