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Individual

MS. MARY LOUISE BREVDA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MA

Contact information

Practice address
228 MAPLE ST, MIDDLEBURY, VT 05753-1606
(802) 388-7435
Mailing address
228 MAPLE ST, MIDDLEBURY, VT 05753-1606
(802) 388-7435

Taxonomy

Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
VT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1002785
VT
01
5693
BLUE CROSS BLUE SHIELD
VT
Enumeration date
04/06/2007
Last updated
07/08/2007
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