Provider Demographics
NPI:1477872711
Name:BURLINGAME, JANE (LPC)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:BURLINGAME
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:956 W 38TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2531
Mailing Address - Country:US
Mailing Address - Phone:814-864-9719
Mailing Address - Fax:814-866-1174
Practice Address - Street 1:956 W 38TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2531
Practice Address - Country:US
Practice Address - Phone:814-864-9719
Practice Address - Fax:814-866-1174
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005455101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional