Healthcare Provider Details

I. General information

NPI: 1164386124
Provider Name (Legal Business Name): BRYNN BASILIERE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 UPPER MAIN ST
MORRISVILLE VT
05661-8494
US

IV. Provider business mailing address

403 UPPER MAIN ST
MORRISVILLE VT
05661-8494
US

V. Phone/Fax

Practice location:
  • Phone: 802-448-0188
  • Fax:
Mailing address:
  • Phone: 802-448-0188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number097.0135968
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: