Provider Demographics
NPI:1639132707
Name:BURR, JEANNETTE AYDELOTTE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEANNETTE
Middle Name:AYDELOTTE
Last Name:BURR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ALLENS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3306
Mailing Address - Country:US
Mailing Address - Phone:585-233-7420
Mailing Address - Fax:
Practice Address - Street 1:120 ALLENS CREEK RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3306
Practice Address - Country:US
Practice Address - Phone:585-233-7420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015363103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY015363OtherNYS LICENSE #
NYP010115363OtherBCBS PROVIDER #