Provider Demographics
NPI:1942254032
Name:BERRIZBEITIA, LAUREN GAIL (LCMHC)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:GAIL
Last Name:BERRIZBEITIA
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2453 NOTCH RD
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:VT
Mailing Address - Zip Code:05465-9566
Mailing Address - Country:US
Mailing Address - Phone:802-434-5462
Mailing Address - Fax:
Practice Address - Street 1:431 PINE ST
Practice Address - Street 2:SUITE 204
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4726
Practice Address - Country:US
Practice Address - Phone:802-862-6931
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0680000658101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT10-11278Medicaid