Provider Demographics
NPI:1376879171
Name:BURMAN, CARLA (MFT)
Entity Type:Individual
Prefix:MS
First Name:CARLA
Middle Name:
Last Name:BURMAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BRIDGE AVE.
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-2040
Mailing Address - Country:US
Mailing Address - Phone:415-488-9118
Mailing Address - Fax:
Practice Address - Street 1:6 BRIDGE ST
Practice Address - Street 2:SUITE 6
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-2040
Practice Address - Country:US
Practice Address - Phone:415-488-9118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC32251106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist