Provider Demographics
NPI:1841337680
Name:BERZINS, LISA GAIL (PHD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:GAIL
Last Name:BERZINS
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 1:91 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2509
Mailing Address - Country:US
Mailing Address - Phone:860-521-2515
Mailing Address - Fax:860-521-8291
Practice Address - Street 1:91 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2509
Practice Address - Country:US
Practice Address - Phone:860-521-2515
Practice Address - Fax:860-521-8291
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1368103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical