Provider Demographics
NPI:1396852083
Name:BURGIO, JOANNE CITRON (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:CITRON
Last Name:BURGIO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 W OVERLAND RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6541
Mailing Address - Country:US
Mailing Address - Phone:208-519-9102
Mailing Address - Fax:208-550-3483
Practice Address - Street 1:943 W OVERLAND RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6541
Practice Address - Country:US
Practice Address - Phone:208-519-9102
Practice Address - Fax:208-550-3483
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY203093103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical