Provider Demographics
NPI:1396984548
Name:LIEBERMAN, BETHANY A (PSYD)
Entity type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:A
Last Name:LIEBERMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5297
Mailing Address - Country:US
Mailing Address - Phone:802-865-3450
Mailing Address - Fax:802-860-5011
Practice Address - Street 1:15 PINECREST DR
Practice Address - Street 2:
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-2912
Practice Address - Country:US
Practice Address - Phone:802-288-1087
Practice Address - Fax:802-878-4404
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0480000920103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical