Provider Demographics
NPI:1114426301
Name:BURLINGAME, ELISABETH ANN MARIE (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:ELISABETH
Middle Name:ANN MARIE
Last Name:BURLINGAME
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 OREGON ST STE 4
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-5723
Mailing Address - Country:US
Mailing Address - Phone:563-554-2337
Mailing Address - Fax:
Practice Address - Street 1:801 OREGON ST STE 4
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-5723
Practice Address - Country:US
Practice Address - Phone:563-554-2337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA113538104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker