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General NPI Number Information
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NPI Number | 1093031320
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Entity Type | Individual
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Provider Name | CORI CIEURZO LIPTAK PHD
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Gender | Female
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Dates
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Enumeration Date | 04/12/2010
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 450 BROOKLINE AVE
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City | BOSTON
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State | MA
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Zip | 02215-5418
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Country | US
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Telephone | 617-632-5923
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Fax |
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Provider Business Mailing Address
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Address Line | 135 WARREN DR
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City | NORFOLK
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State | MA
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Zip | 02056-4001
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Country | US
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Telephone | 617-519-6947
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 8267
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 8267
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License Number State | MA
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