Individual
DR. CAROLYN BASILIERE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
156 COLLEGE ST, STE 201, BURLINGTON, VT 05401-8423
(802) 657-3647
(802) 860-0183
Mailing address
11 SIMPSON CT, SOUTH BURLINGTON, VT 05403-6326
(802) 657-3647
(802) 860-0183
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
048.0000752
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1008273
—
VT
01
—
23-7182584
COMMUNITY HEALTH CENTERS OF BURLINGTON
VT
01
—
58533
BLUE CROSS BLUE SHIELD
VT
01
—
785938
MVP
VT
Enumeration date
11/22/2006
Last updated
09/21/2021
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