Provider Demographics
NPI:1003164187
Name:BURNSIDE, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BURNSIDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 E WILLIAMS FIELD RD STE 200
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-0764
Mailing Address - Country:US
Mailing Address - Phone:480-490-4486
Mailing Address - Fax:
Practice Address - Street 1:3910 S RURAL RD
Practice Address - Street 2:SUITE J
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-5581
Practice Address - Country:US
Practice Address - Phone:480-317-9868
Practice Address - Fax:480-317-9867
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical