Healthcare Provider Details

I. General information

NPI: 1396984548
Provider Name (Legal Business Name): BETHANY A. LIEBERMAN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 PINECREST DR
ESSEX JUNCTION VT
05452-2912
US

IV. Provider business mailing address

86 LAKE ST
BURLINGTON VT
05401-5297
US

V. Phone/Fax

Practice location:
  • Phone: 802-288-1087
  • Fax: 802-878-4404
Mailing address:
  • Phone: 802-865-3450
  • Fax: 802-860-5011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0480000920
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: