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Individual

TINA L BLEAU

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.A.

Contact information

Practice address
30 AIRPORT RD, S BURLINGTON, VT 05403-6432
(802) 658-3924
(802) 658-0216
Mailing address
11 TAFT ST, ESSEX JUNCTION, VT 05452-3150
(802) 288-9986

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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