Provider Demographics
NPI:1639233018
Name:BIALIK, BURTON (PHD, MFT)
Entity Type:Individual
Prefix:
First Name:BURTON
Middle Name:
Last Name:BIALIK
Suffix:
Gender:M
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4036 VISTA CALAVERAS ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4606
Mailing Address - Country:US
Mailing Address - Phone:760-435-9355
Mailing Address - Fax:760-806-7721
Practice Address - Street 1:2125 S EL CAMINO REAL STE 206
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6260
Practice Address - Country:US
Practice Address - Phone:760-435-9355
Practice Address - Fax:760-806-7721
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC20771106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist