Provider Demographics
NPI:1285927871
Name:VIRGINIA M SHILLER, PH.D., LLC
Entity type:Organization
Organization Name:VIRGINIA M SHILLER, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:203-776-3681
Mailing Address - Street 1:55 WATERTOWN ST UNIT 460
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-6358
Mailing Address - Country:US
Mailing Address - Phone:203-415-7160
Mailing Address - Fax:203-776-3681
Practice Address - Street 1:55 WATERTOWN ST UNIT 460
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-6358
Practice Address - Country:US
Practice Address - Phone:203-415-7160
Practice Address - Fax:203-776-3681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-16
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1236103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004065801Medicaid