Healthcare Provider Details

I. General information

NPI: 1871735787
Provider Name (Legal Business Name): LISA MARIE CEPEDA PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2009
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 COLCHESTER AVE
BURLINGTON VT
05405-1764
US

IV. Provider business mailing address

2 COLCHESTER AVE
BURLINGTON VT
05405-1764
US

V. Phone/Fax

Practice location:
  • Phone: 802-656-2661
  • Fax: 802-656-3485
Mailing address:
  • Phone: 802-656-2661
  • Fax: 802-656-3485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: