Provider Demographics
NPI:1356676357
Name:PHILLIPS-STOLL, ALIZA (PHD)
Entity Type:Individual
Prefix:MS
First Name:ALIZA
Middle Name:
Last Name:PHILLIPS-STOLL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:ALIZA
Other - Middle Name:
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:32 UNION ST
Mailing Address - Street 2:#3
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2057
Mailing Address - Country:US
Mailing Address - Phone:917-689-8887
Mailing Address - Fax:
Practice Address - Street 1:32 UNION ST
Practice Address - Street 2:#3
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-2057
Practice Address - Country:US
Practice Address - Phone:917-689-8887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-08
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10386103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist