Basic Information
| Provider Information | |||||||||
| NPI: | 1396984548 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LIEBERMAN | ||||||||
| FirstName: | BETHANY | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 86 LAKE ST | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054015297 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028653450 | ||||||||
| FaxNumber: | 8028605011 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 PINECREST DR | ||||||||
| Address2: | |||||||||
| City: | ESSEX JUNCTION | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054522912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8022881087 | ||||||||
| FaxNumber: | 8028784404 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2009 | ||||||||
| LastUpdateDate: | 02/11/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 0480000920 | VT | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.