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TINA L BLEAU M.A.
Clinical Child & Adolescent >> Psychologist >> Behavioral Health & Social Service ProvidersRegistrant NPI Number: 1427110188
Individual Registrant: TINA L BLEAU M.A.
Gender: F
Not Sole Proprietor
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
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: --
Tel: 802-288-9986 Fax: --
Registration Information:
NPI: 1427110188
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 103TC2200X | Behavioral Health & Social Service Providers Psychologist Clinical Child & Adolescent | VT | 047-0000688 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 1011221 | VT | 05 | |
| CIGNA PROVIDER NUMBER | 2252996 | VT | 01 |
| MVP PROVIDER NUMBER | 389998 | VT | 01 |
| BC BS PROVIDER NUMBER | 00048412 | VT | 01 |
