Provider Demographics
NPI:1508179094
Name:BURDO, EKATERINA VICTORIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EKATERINA
Middle Name:VICTORIA
Last Name:BURDO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:45 FOTTLER RD
Mailing Address - Street 2:APT 3
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-3140
Mailing Address - Country:US
Mailing Address - Phone:617-849-1033
Mailing Address - Fax:617-522-7888
Practice Address - Street 1:170 MORTON ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-3735
Practice Address - Country:US
Practice Address - Phone:617-371-3888
Practice Address - Fax:617-522-7888
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8920103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical