Individual
LISA M. STEPHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
145 PINE HAVEN SHORES RD STE 2294, SHELBURNE, VT 05482-7703
(802) 876-1100
(802) 876-1101
Mailing address
PO BOX 302, JERICHO, VT 05465-0302
(802) 355-9299
(802) 419-3399
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
048-0000778
VT
103TC0700X
Clinical Psychologist
Primary
0480000778
VT
103TC1900X
Counseling Psychologist
048-0000778
VT
103TC2200X
Clinical Child & Adolescent Psychologist
048-0000778
VT
103TF0000X
Family Psychologist
048-0000778
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1011334
—
VT
01
—
113769
TEAMSTERS BENEFIT HEALTH
VT
01
—
189876000
MAGELLEN
VT
01
—
2060312
CIGNA BEHAVIORAL HEALTH
VT
01
—
362-58036
BLUE CROSS/BLUE SHIELD
VT
01
—
415801
MVP HEALTHCARE
VT
01
—
87726
UNITED BEHAVIORAL HEALTH
VT
Enumeration date
10/06/2006
Last updated
04/05/2025
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