Provider Demographics
NPI:1841969482
Name:CAROLYN EDWARDS BASILIERE LLC
Entity type:Organization
Organization Name:CAROLYN EDWARDS BASILIERE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:EDWARDS
Authorized Official - Last Name:BASILIERE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:802-657-3647
Mailing Address - Street 1:11 SIMPSON CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6326
Mailing Address - Country:US
Mailing Address - Phone:802-657-3647
Mailing Address - Fax:802-860-0183
Practice Address - Street 1:156 COLLEGE ST STE 201
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8423
Practice Address - Country:US
Practice Address - Phone:802-657-3647
Practice Address - Fax:802-860-0183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty