Provider Demographics
NPI:1922039353
Name:LISS, MARCIA (PHD)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:LISS
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 1:1351 S COUNTY TRL
Mailing Address - Street 2:BUILDING 2 SUITE 210
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-5079
Mailing Address - Country:US
Mailing Address - Phone:401-884-2088
Mailing Address - Fax:401-884-2075
Practice Address - Street 1:1351 S COUNTY TRL
Practice Address - Street 2:BUILDING 2 SUITE 210
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-5079
Practice Address - Country:US
Practice Address - Phone:401-884-2088
Practice Address - Fax:401-884-2075
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00692103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RICOORDINATED HEALTH POther407788
RI30027-8OtherBLUE CROSS BLUE SHIELD