Provider Demographics
NPI:1528418613
Name:BOMBERGER, ELIZABETH (LCMHC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BOMBERGER
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 PLACE RD E
Mailing Address - Street 2:
Mailing Address - City:HINESBURG
Mailing Address - State:VT
Mailing Address - Zip Code:05461-8906
Mailing Address - Country:US
Mailing Address - Phone:802-735-7416
Mailing Address - Fax:
Practice Address - Street 1:157 PLACE RD E
Practice Address - Street 2:
Practice Address - City:HINESBURG
Practice Address - State:VT
Practice Address - Zip Code:05461-8906
Practice Address - Country:US
Practice Address - Phone:802-355-7416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0680128376101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health