Provider Demographics
NPI:1447734421
Name:WASHINGTON, BURTON
Entity Type:Individual
Prefix:
First Name:BURTON
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 REVEREND RICHARD WILSON DR
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70062-7661
Mailing Address - Country:US
Mailing Address - Phone:504-472-0068
Mailing Address - Fax:504-472-0078
Practice Address - Street 1:2145 REVEREND RICHARD WILSON DR
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70062-7661
Practice Address - Country:US
Practice Address - Phone:504-472-0068
Practice Address - Fax:504-472-0078
Is Sole Proprietor?:No
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator