Provider Demographics
NPI:1043797301
Name:BURNS, REILLY ELIZABETH
Entity Type:Individual
Prefix:
First Name:REILLY
Middle Name:ELIZABETH
Last Name:BURNS
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 1:2414 P ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-6264
Mailing Address - Country:US
Mailing Address - Phone:916-770-7012
Mailing Address - Fax:
Practice Address - Street 1:9370 W STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-8013
Practice Address - Country:US
Practice Address - Phone:877-828-8476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst