Provider Demographics
NPI:1346442431
Name:WOLLHEIM, ILIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:ILIZABETH
Middle Name:
Last Name:WOLLHEIM
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 1:175 WINTHROP RD # 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-4642
Mailing Address - Country:US
Mailing Address - Phone:617-566-7629
Mailing Address - Fax:
Practice Address - Street 1:1693 BEACON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-4494
Practice Address - Country:US
Practice Address - Phone:617-566-7629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7877103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical