Provider Demographics
NPI:1093025512
Name:BURDICK, JEFFREY
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:BURDICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FENN ST
Mailing Address - Street 2:ADMINISTRATIVE OFFICES
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-6278
Mailing Address - Country:US
Mailing Address - Phone:413-629-1251
Mailing Address - Fax:413-448-2198
Practice Address - Street 1:1 FENN ST
Practice Address - Street 2:ADMINISTRATIVE OFFICES
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-6278
Practice Address - Country:US
Practice Address - Phone:413-629-1251
Practice Address - Fax:413-448-2198
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor