Provider Demographics
NPI:1295835858
Name:DODD, LISBETH A (LICSW)
Entity Type:Individual
Prefix:
First Name:LISBETH
Middle Name:A
Last Name:DODD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-3633
Mailing Address - Country:US
Mailing Address - Phone:802-224-1033
Mailing Address - Fax:
Practice Address - Street 1:79 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-3173
Practice Address - Country:US
Practice Address - Phone:802-224-1033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2011-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT08900008241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1060830OtherCIGNA BEHAVIORAL HEALTH
576753OtherVALUE OPTIONS
VT1432750OtherCOVENTRY HEALTH CARE
VT39952OtherBLUE CROSS BLUE SHIELD
VT1010043Medicaid
410723OtherTRICARE
VTVN3606Medicare ID - Type Unspecified