Provider Demographics
NPI:1629631742
Name:BURTON, JOSEPH MATHEW (RMHCI)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MATHEW
Last Name:BURTON
Suffix:
Gender:M
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1062 HOOPER AVE NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-4512
Mailing Address - Country:US
Mailing Address - Phone:502-548-0869
Mailing Address - Fax:
Practice Address - Street 1:7095 TURNER RD
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5728
Practice Address - Country:US
Practice Address - Phone:321-446-2113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17960101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health