Provider Demographics
NPI:1144569229
Name:BURGDORF BURCINA, DEANNA (MFT INTERN)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:BURGDORF BURCINA
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16275 MONTEREY RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-5466
Mailing Address - Country:US
Mailing Address - Phone:408-778-5120
Mailing Address - Fax:
Practice Address - Street 1:16275 MONTEREY RD
Practice Address - Street 2:SUITE C
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-5466
Practice Address - Country:US
Practice Address - Phone:408-778-5120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72025106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist