Provider Demographics
NPI:1497291066
Name:BURNHAM, ERICA
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:BURNHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:CANAAN
Mailing Address - State:NH
Mailing Address - Zip Code:03741-7644
Mailing Address - Country:US
Mailing Address - Phone:603-523-8804
Mailing Address - Fax:603-523-8804
Practice Address - Street 1:44 ROBERTS RD
Practice Address - Street 2:
Practice Address - City:CANAAN
Practice Address - State:NH
Practice Address - Zip Code:03741-7644
Practice Address - Country:US
Practice Address - Phone:603-523-8804
Practice Address - Fax:603-523-8804
Is Sole Proprietor?:No
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor