Provider Demographics
NPI:1033547401
Name:BURT, PATRICIA (RN, MSN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:BURT
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 HENRY AVE
Mailing Address - Street 2:STE 500
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1121
Mailing Address - Country:US
Mailing Address - Phone:215-473-0772
Mailing Address - Fax:
Practice Address - Street 1:3300 HENRY AVE
Practice Address - Street 2:STE 500
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19129-1121
Practice Address - Country:US
Practice Address - Phone:215-473-0772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPB216509103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth