Provider Demographics
NPI:1952799694
Name:LISA M. STEPHEN PH.D., PC
Entity Type:Organization
Organization Name:LISA M. STEPHEN PH.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:STEPHEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:802-355-9299
Mailing Address - Street 1:PO BOX 1034
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:VT
Mailing Address - Zip Code:05465-1034
Mailing Address - Country:US
Mailing Address - Phone:802-355-9299
Mailing Address - Fax:802-419-3399
Practice Address - Street 1:89 RYE CIR STE 1
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7632
Practice Address - Country:US
Practice Address - Phone:802-355-9299
Practice Address - Fax:802-419-3399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-05
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT048-0000778103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty