1366402927 NPI number — MRS. ROBIN LYNN BURGESS MA

Table of content: MRS. ROBIN LYNN BURGESS MA (NPI 1366402927)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366402927 NPI number — MRS. ROBIN LYNN BURGESS MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURGESS
Provider First Name:
ROBIN
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA
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:
1366402927
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
168 ANTHONY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-434-4242
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
610 WAMPANOAG TR
Provider Second Line Business Practice Location Address:
EAST BAY MENTAL HEALTH
Provider Business Practice Location Address City Name:
EAST PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-431-9870
Provider Business Practice Location Address Fax Number:
401-438-1957
Provider Enumeration Date:
03/27/2006

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: RC53476 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".




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