Provider Demographics
NPI:1477535219
Name:ROSENBLAD, LINDA VIETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:VIETH
Last Name:ROSENBLAD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 772
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-0772
Mailing Address - Country:US
Mailing Address - Phone:802-598-9265
Mailing Address - Fax:
Practice Address - Street 1:5224 SHELBURNE RD
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-6621
Practice Address - Country:US
Practice Address - Phone:802-598-9265
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT048-0000815103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009437Medicaid
VT1009437Medicaid