Provider Demographics
NPI:1073594479
Name:BURTON, LISA MARIE (PHD,ARNP, PMHCNS)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:BURTON
Suffix:
Gender:F
Credentials:PHD,ARNP, PMHCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 ELVIRA LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-1814
Mailing Address - Country:US
Mailing Address - Phone:786-300-5776
Mailing Address - Fax:
Practice Address - Street 1:66 ELVIRA LN
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-1814
Practice Address - Country:US
Practice Address - Phone:786-300-5776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN1986612363LP0808X
CT006971363LP0808X
FL1986612364SP0808X
CT6971363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1073594479Medicaid
FL306453101Medicaid
CT119551OtherBEACON HEALTH OPTIONS(VALUE OPTIONS)
CT7500659OtherAETNA
CT1073594479OtherCIGNA
CT1073594479OtherUNITED BEHAVIORAL HEALTH:
CTP6402249OtherOXFORD
CT1073594479OtherANTHEM BLUE CROSS
FL742000000OtherMAGELLAN BEHAVIORAL HEALT
CTD400590987Medicaid