Provider Demographics
NPI:1396364311
Name:BURRITT, SMRITY SINGH
Entity Type:Individual
Prefix:
First Name:SMRITY
Middle Name:SINGH
Last Name:BURRITT
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 1:2133 FAIRFAX PL
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-8033
Mailing Address - Country:US
Mailing Address - Phone:707-494-0153
Mailing Address - Fax:
Practice Address - Street 1:2133 FAIRFAX PL
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-8033
Practice Address - Country:US
Practice Address - Phone:707-494-0153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician