Provider Demographics
NPI:1538241823
Name:MORGENS, LIANA PENA (PHD)
Entity type:Individual
Prefix:DR
First Name:LIANA
Middle Name:PENA
Last Name:MORGENS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LIANA
Other - Middle Name:MURIEL
Other - Last Name:PENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:75 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721-1986
Mailing Address - Country:US
Mailing Address - Phone:508-309-3055
Mailing Address - Fax:
Practice Address - Street 1:298 CRESCENT ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-3803
Practice Address - Country:US
Practice Address - Phone:781-899-1160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7910103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW06086OtherBCBS
MA7910OtherLICENSE