Provider Demographics
NPI:1184835001
Name:SEARLES, TANYA REXFORD (MA)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:REXFORD
Last Name:SEARLES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 MAIN ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-6104
Mailing Address - Country:US
Mailing Address - Phone:802-334-6280
Mailing Address - Fax:
Practice Address - Street 1:194 MAIN ST
Practice Address - Street 2:SUITE 210
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-6104
Practice Address - Country:US
Practice Address - Phone:802-334-6280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT703103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008666Medicaid
VT890098OtherMVP
VT58683OtherBLUE CROSS & BLUE SHIELD