Provider Demographics
NPI:1508130089
Name:BURNS, KENNETH R (LCSW)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:R
Last Name:BURNS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RABRO DR STE 10
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-4270
Mailing Address - Country:US
Mailing Address - Phone:631-257-5900
Mailing Address - Fax:631-257-5900
Practice Address - Street 1:1 RABRO DR STE 10
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-4270
Practice Address - Country:US
Practice Address - Phone:631-257-5900
Practice Address - Fax:631-706-4727
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-01
Last Update Date:2020-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0825351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical