Provider Demographics
NPI:1003541194
Name:BURKINS, FAITH GRACIELA
Entity Type:Individual
Prefix:MS
First Name:FAITH
Middle Name:GRACIELA
Last Name:BURKINS
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 1:1136 35TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32968-4909
Mailing Address - Country:US
Mailing Address - Phone:772-696-1681
Mailing Address - Fax:
Practice Address - Street 1:5855 40TH LN
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32966-6520
Practice Address - Country:US
Practice Address - Phone:407-908-5672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician