Provider Demographics
NPI:1871735787
Name:CEPEDA, LISA MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:CEPEDA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 COLCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05405-1764
Mailing Address - Country:US
Mailing Address - Phone:802-656-2661
Mailing Address - Fax:802-656-3485
Practice Address - Street 1:2 COLCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05405-1764
Practice Address - Country:US
Practice Address - Phone:802-656-2661
Practice Address - Fax:802-656-3485
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling