Healthcare Provider Details

I. General information

NPI: 1164544516
Provider Name (Legal Business Name): LAURA ANNE BASILI PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 S PLEASANT ST
MIDDLEBURY VT
05753-1479
US

IV. Provider business mailing address

239 CIDER MILL RD
CORNWALL VT
05753-8675
US

V. Phone/Fax

Practice location:
  • Phone: 802-989-8976
  • Fax:
Mailing address:
  • Phone: 802-989-8976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number#863
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number#863
License Number StateVT
# 3
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number#863
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: