MEDICARE: VIRGINIA M SHILLER, PH.D., LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	1236	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285927871
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRGINIA M SHILLER, PH.D., LLC

Provider Business Mailing Address
First Line	:	55 WATERTOWN ST UNIT 460
Second Line	:
City	:	LEXINGTON
State	:	MA
Zip	:	02421-6358
Country	:	US
Telephone Number	:	203-415-7160
Fax Number	:	203-776-3681

Provider Business Practice Location Address
First Line	:	55 WATERTOWN ST UNIT 460
Second Line	:
City	:	LEXINGTON
State	:	MA
Zip	:	02421-6358
Country	:	US
Telephone Number	:	203-415-7160
Fax Number	:	203-776-3681

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. VIRGINIA M SHILLER
Credential	:	PH.D.
Telephone Number	:	203-776-3681

Provider Enumeration Date	:	05/16/2011
Last Update Date	:	09/08/2025

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