Provider Demographics
NPI:1407996861
Name:BURNS, COLLEEN A (MA LMHC LADCI BHDR)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:A
Last Name:BURNS
Suffix:
Gender:F
Credentials:MA LMHC LADCI BHDR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1093 BEACON ST STE 307
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5623
Mailing Address - Country:US
Mailing Address - Phone:617-470-4499
Mailing Address - Fax:617-277-2524
Practice Address - Street 1:1170 BEACON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3963
Practice Address - Country:US
Practice Address - Phone:617-470-4499
Practice Address - Fax:617-277-2524
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4955101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALM0950OtherBCBS PROVIDER NUMBER