Provider Demographics
NPI:1467421925
Name:BURNETT, RICHARD W (LSCSW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:W
Last Name:BURNETT
Suffix:
Gender:M
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 E IRON AVE
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-3236
Mailing Address - Country:US
Mailing Address - Phone:785-823-3654
Mailing Address - Fax:785-827-1280
Practice Address - Street 1:1508 E IRON AVE
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-3236
Practice Address - Country:US
Practice Address - Phone:785-823-3654
Practice Address - Fax:785-827-1280
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSR30863Medicare UPIN
KS070131Medicare ID - Type Unspecified