Active NPI
Gillian Boudreau, PH.D.
- Clinical Psychologist
- South Burlington, VT
National Provider Identifier
1386893683
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 048.0072593
- Practice address
- 364 Dorset St
Suite 212
South Burlington, VT 05403-6270 - Phone
- (802) 658-9440
- NPI assigned
- Sep 11, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| School Psychologist | 103TS0200X | |||
| Clinical Psychologist | 103TC0700X | 048.0072593 | VT | Primary |
Addresses
Primary practice location
364 Dorset St
Suite 212
South Burlington, VT 05403-6270
Mailing address
364 Dorset St
Suite 212
South Burlington, VT 05403-6270
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12350163 | Other | CAQH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Previously, effective Sep 4, 2024 through Sep 4, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 048.0072593 | VT | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1221091200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1336953600000",
"number": "1386893683",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "364 DORSET ST",
"address_2": "SUITE 212",
"city": "SOUTH BURLINGTON",
"state": "VT",
"postal_code": "054036270"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "364 DORSET ST",
"address_2": "SUITE 212",
"city": "SOUTH BURLINGTON",
"state": "VT",
"postal_code": "054036270",
"telephone_number": "802-658-9440"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUDREAU",
"first_name": "GILLIAN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-09-11",
"last_updated": "2012-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "VT",
"license": "048.0072593",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "12350163",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in South Burlington, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.