1114123130 NPI number — DEBORAH JANE BURTON LCSW

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114123130 NPI number — DEBORAH JANE BURTON LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURTON
Provider First Name:
DEBORAH
Provider Middle Name:
JANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114123130
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 EMELINE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA CRUZ
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95060-1976
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-454-4170
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 W BEACH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATSONVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95076-4504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-763-8999
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCS9438 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ZZZ92069Z . This is a "MEDICARE GROUP PTAN#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ91891Z . This is a "MEDICARE GROUP PTAN#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: MFC 23772 . This is a "PROFESSIONAL LICENSE#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ91892Z . This is a "MEDICARE GROUP PTAN#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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