Provider Demographics
NPI:1295951432
Name:BREITMEYER, JUDITH JOANN (MA,MA)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:JOANN
Last Name:BREITMEYER
Suffix:
Gender:F
Credentials:MA,MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 DUBOIS DRIVE
Mailing Address - Street 2:
Mailing Address - City:S. BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7641
Mailing Address - Country:US
Mailing Address - Phone:802-862-9590
Mailing Address - Fax:
Practice Address - Street 1:2 CHURCH ST STE 2D
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4284
Practice Address - Country:US
Practice Address - Phone:802-658-9590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health