Provider Demographics
NPI:1598992844
Name:BURNETTE, DANA L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:L
Last Name:BURNETTE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 3RD ST S STE 300
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-4058
Mailing Address - Country:US
Mailing Address - Phone:904-545-3239
Mailing Address - Fax:
Practice Address - Street 1:2320 3RD ST S STE 300
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-4058
Practice Address - Country:US
Practice Address - Phone:904-545-3239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-14
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW59861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW5986OtherSTATE OF FLORIDA