Healthcare Provider Details

I. General information

NPI: 1194044909
Provider Name (Legal Business Name): SARAH JUDITH LAWRENCE LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH JUDITH LICHTENSTEIN LCPC

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1138 PINE ST
BURLINGTON VT
05401-5353
US

IV. Provider business mailing address

208 FLYNN AVE STE 3J
BURLINGTON VT
05401-5420
US

V. Phone/Fax

Practice location:
  • Phone: 802-488-6600
  • Fax: 802-488-6919
Mailing address:
  • Phone: 802-488-6920
  • Fax: 802-488-6919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1477
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068.0117128
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: