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TINA L BLEAU M.A.

Clinical Child & Adolescent >> Psychologist >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1427110188

Individual Registrant:
 TINA L BLEAU M.A.
Gender: F
Not Sole Proprietor

Location and contact information for practice:
30 AIRPORT RD  S BURLINGTON, VT 05403-6432 US
Tel: 802-658-3924  Fax: 802-658-0216

Contact information for business:
11 TAFT ST  ESSEX JUNCTION, VT 05452-3150 US
Tel: 802-288-9986  Fax: --

Registration Information:
NPI: 1427110188
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y103TC2200XBehavioral Health & Social Service Providers
Psychologist
Clinical Child & Adolescent
VT047-0000688

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
1011221VT05
CIGNA PROVIDER NUMBER2252996VT01
MVP PROVIDER NUMBER389998VT01
BC BS PROVIDER NUMBER00048412VT01




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