Provider Demographics
NPI:1609049899
Name:BURLESON, BRUCE D
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:D
Last Name:BURLESON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 THATCHER ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-3944
Mailing Address - Country:US
Mailing Address - Phone:617-970-9255
Mailing Address - Fax:
Practice Address - Street 1:180 CENTRE ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-2733
Practice Address - Country:US
Practice Address - Phone:508-586-6300
Practice Address - Fax:508-580-1527
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)