Provider Demographics
NPI:1619035847
Name:KATE, LISA (LAC, LCMHC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:KATE
Suffix:
Gender:F
Credentials:LAC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 COTTAGE ST
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-6560
Mailing Address - Country:US
Mailing Address - Phone:717-706-4826
Mailing Address - Fax:
Practice Address - Street 1:11 COTTAGE ST
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6560
Practice Address - Country:US
Practice Address - Phone:717-706-4826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDUO2575171100000X
VT091.0134085171100000X
VT068.0000493101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171100000XOther Service ProvidersAcupuncturist