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General NPI Number Information
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NPI Number | 1932719150
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Entity Type | Individual
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Provider Name | ELIZA GRACE POLLI PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 08/03/2020
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Last Update Date | 08/03/2020
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Provider Practice Location Address
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Address Line | 45 LYME RD STE 305A
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City | HANOVER
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State | NH
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Zip | 03755-1219
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Country | US
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Telephone | 833-866-6873
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Fax |
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Provider Business Mailing Address
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Address Line | 66 CASCADNAC AVE
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City | WHITE RIVER JUNCTION
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State | VT
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Zip | 05001-8139
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Country | US
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Telephone | 603-667-6857
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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 |
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License Number State |
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