Provider Demographics
NPI:1447325550
Name:BASILIERE, CAROLYN (PHD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:
Last Name:BASILIERE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:EDWARDS
Other - Last Name:BASILIERE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:11 SIMPSON CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6326
Mailing Address - Country:US
Mailing Address - Phone:802-657-3647
Mailing Address - Fax:802-860-0183
Practice Address - Street 1:156 COLLEGE ST
Practice Address - Street 2:STE 201
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8423
Practice Address - Country:US
Practice Address - Phone:802-657-3647
Practice Address - Fax:802-860-0183
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT048.0000752103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT58533OtherBLUE CROSS BLUE SHIELD
VT23-7182584OtherCOMMUNITY HEALTH CENTERS OF BURLINGTON
VT785938OtherMVP
VT1008273Medicaid
VT23-7182584OtherCOMMUNITY HEALTH CENTERS OF BURLINGTON