Provider Demographics
NPI:1508945965
Name:SILBERSTEIN, LISA R (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:R
Last Name:SILBERSTEIN
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 1:28 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:CT
Mailing Address - Zip Code:06426-1100
Mailing Address - Country:US
Mailing Address - Phone:860-767-1517
Mailing Address - Fax:860-767-7703
Practice Address - Street 1:28 MAIN ST
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:CT
Practice Address - Zip Code:06426-1100
Practice Address - Country:US
Practice Address - Phone:860-767-1517
Practice Address - Fax:860-767-7703
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001483103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist