Provider Demographics
NPI:1598968828
Name:BURNS, EDWARD R (LMFT STATE OF CT)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:R
Last Name:BURNS
Suffix:
Gender:M
Credentials:LMFT STATE OF CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 GOSHEN RD
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06759-1549
Mailing Address - Country:US
Mailing Address - Phone:860-567-0373
Mailing Address - Fax:
Practice Address - Street 1:288 GOSHEN RD
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:CT
Practice Address - Zip Code:06759-1549
Practice Address - Country:US
Practice Address - Phone:860-567-0373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000751106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT410000751CT02Medicare UPIN