Provider Demographics
NPI:1457836314
Name:BURTON JOSSELYN, ERIN (LCSW)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:BURTON JOSSELYN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:BURTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:125 BETHANY DR STE 203
Mailing Address - Street 2:
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-2803
Mailing Address - Country:US
Mailing Address - Phone:831-498-4445
Mailing Address - Fax:
Practice Address - Street 1:125 BETHANY DR STE 203
Practice Address - Street 2:
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066
Practice Address - Country:US
Practice Address - Phone:831-498-4445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-26
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA828141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical