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General NPI Number Information
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NPI Number | 1699862342
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Entity Type | Individual
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Provider Name | LISA M. STEPHEN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 04/05/2025
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Provider Practice Location Address
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Address Line | 145 PINE HAVEN SHORES RD STE 2294
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City | SHELBURNE
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State | VT
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Zip | 05482-7703
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Country | US
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Telephone | 802-876-1100
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Fax | 802-876-1101
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Provider Business Mailing Address
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Address Line | PO BOX 302
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City | JERICHO
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State | VT
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Zip | 05465-0302
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Country | US
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Telephone | 802-355-9299
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Fax | 802-419-3399
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 048-0000778
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 048-0000778
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License Number State | VT
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Taxonomy #3
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 048-0000778
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License Number State | VT
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Taxonomy #4
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number | 048-0000778
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License Number State | VT
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Taxonomy #5
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0480000778
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License Number State | VT
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