1316297187 NPI number — MRS. JESSICA ROMANOFF BURTON LCPC

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 1316297187 NPI number — MRS. JESSICA ROMANOFF BURTON LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURTON
Provider First Name:
JESSICA
Provider Middle Name:
ROMANOFF
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROMANOFF
Provider Other First Name:
JESSICA
Provider Other Middle Name:
BRITTING
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1316297187
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 113
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH WINDHAM
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04082-0113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-671-3553
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32 TANDBERG TRL UNIT 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINDHAM
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04062-6417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-671-3553
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/19/2012

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: 101YM0800X , with the licence number:  CC5183 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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