Provider Demographics
NPI:1487084299
Name:ROBERT LISS, PH.D., INC.
Entity type:Organization
Organization Name:ROBERT LISS, PH.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LISS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:415-668-2502
Mailing Address - Street 1:2284 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1007
Mailing Address - Country:US
Mailing Address - Phone:415-668-2502
Mailing Address - Fax:
Practice Address - Street 1:2284 FULTON ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1007
Practice Address - Country:US
Practice Address - Phone:415-668-2502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-14
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9288103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty