Provider Demographics
NPI:1124554126
Name:BURCHETTE, ANISSA LENORA
Entity Type:Individual
Prefix:
First Name:ANISSA
Middle Name:LENORA
Last Name:BURCHETTE
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 1:3501 W VINE ST
Mailing Address - Street 2:SUITE 344
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4643
Mailing Address - Country:US
Mailing Address - Phone:407-501-5839
Mailing Address - Fax:
Practice Address - Street 1:3501 W VINE ST
Practice Address - Street 2:SUITE 344
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4643
Practice Address - Country:US
Practice Address - Phone:407-501-5839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker