Provider Demographics
NPI:1871019273
Name:LABEAU, GERALD M
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:M
Last Name:LABEAU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 TOWN CRIER DR
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-8669
Mailing Address - Country:US
Mailing Address - Phone:802-258-4623
Mailing Address - Fax:
Practice Address - Street 1:16 TOWN CRIER DR
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-8669
Practice Address - Country:US
Practice Address - Phone:802-258-4623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTNAOtherNA