MEDICARE: DR. NICOLE LAFKO BRESLEND PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	048.0134739	VT

General Provider Information

NPI Number	:	1356042857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE LAFKO BRESLEND PH.D.

Provider Business Mailing Address
First Line	:	26 CHARLES ST
Second Line	:
City	:	SOUTH BURLINGTON
State	:	VT
Zip	:	05403-5909
Country	:	US
Telephone Number	:	802-299-0862
Fax Number	:

Provider Business Practice Location Address
First Line	:	89 MAIN ST
Second Line	:
City	:	ESSEX JUNCTION
State	:	VT
Zip	:	05452-3200
Country	:	US
Telephone Number	:	802-676-1570
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2023
Last Update Date	:	03/13/2023

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