Provider Demographics
NPI:1336512961
Name:BURNHAM, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:BURNHAM
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 1:52 WATER ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HALLOWELL
Mailing Address - State:ME
Mailing Address - Zip Code:04347-1437
Mailing Address - Country:US
Mailing Address - Phone:207-430-3777
Mailing Address - Fax:
Practice Address - Street 1:52 WATER ST
Practice Address - Street 2:SUITE 2
Practice Address - City:HALLOWELL
Practice Address - State:ME
Practice Address - Zip Code:04347-1437
Practice Address - Country:US
Practice Address - Phone:207-430-3777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC5094101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)