Provider Demographics
NPI:1063858231
Name:BURTON, DEANA R
Entity Type:Individual
Prefix:MRS
First Name:DEANA
Middle Name:R
Last Name:BURTON
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 1:2216 S MIAMI BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-6281
Mailing Address - Country:US
Mailing Address - Phone:917-510-3904
Mailing Address - Fax:
Practice Address - Street 1:2216 S MIAMI BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-6281
Practice Address - Country:US
Practice Address - Phone:917-510-3904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0080251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical