Provider Demographics
NPI:1437832433
Name:LEBOWITZ, THERESA SOPHIA (MS)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:SOPHIA
Last Name:LEBOWITZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 MAIN ST APT 205
Mailing Address - Street 2:
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404-1436
Mailing Address - Country:US
Mailing Address - Phone:802-922-3970
Mailing Address - Fax:
Practice Address - Street 1:355 MAIN ST APT 205
Practice Address - Street 2:
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404-1436
Practice Address - Country:US
Practice Address - Phone:802-922-3970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0135408101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health