Provider Demographics
NPI:1982667275
Name:CHALMER, BRUCE JEFFREY (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:JEFFREY
Last Name:CHALMER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 ARLINGTON GRN
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7001
Mailing Address - Country:US
Mailing Address - Phone:802-860-6671
Mailing Address - Fax:
Practice Address - Street 1:27 RYE CIRCLE
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403
Practice Address - Country:US
Practice Address - Phone:802-860-6671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-09
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT048-0000627103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT958272OtherMVP PROVIDER NUMBER
VT28080OtherBLUE CROSS/BLUE SHIELD
VT1004950Medicaid
1049972OtherCIGNA PROVIDER #
1049972OtherCIGNA PROVIDER #