Doctor Name: | DR. LISA SHAW |
NPI Number: | 1982740627 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PH.D. |
License Number: | 3659 |
Business Practice Address: | 344 Harvard St Suite #1 Brookline, MA - 024462917 |
Business Phone Number: | 6172776286 |
Business Fax Number: | 6172776286 |
Mailing Address: | 56 Marshal St # 3, BROOKLINE |
State: | MA |
Postal Code: | 024465423 |
Phone Number: | 6172776286 |
Fax Number: | 6172776286 |
NPI Enumeration Date: | 01/29/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103G00000X |
License Number: | 3659 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | MA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Clinical Neuropsychologist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |