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Individual
TINA L BLEAU
Active
Individual
TINA L BLEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A.
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
047-0000688
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00048412
BC BS PROVIDER NUMBER
VT
05
—
1011221
—
VT
01
—
2252996
CIGNA PROVIDER NUMBER
VT
01
—
389998
MVP PROVIDER NUMBER
VT
Enumeration date
12/15/2006
Last updated
07/09/2007
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