Basic Information
| Provider Information | |||||||||
| NPI: | 1194044909 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAWRENCE | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | JUDITH | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCMHC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LICHTENSTEIN | ||||||||
| OtherFirstName: | SARAH | ||||||||
| OtherMiddleName: | JUDITH | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LCPC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 208 FLYNN AVE STE 3J | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054015420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8024886920 | ||||||||
| FaxNumber: | 8024886919 | ||||||||
| Practice Location | |||||||||
| Address1: | 1138 PINE ST | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054015353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8024886600 | ||||||||
| FaxNumber: | 8024886919 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2010 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 1477 | MT | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YM0800X | 068.0117128 | VT | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.