Provider Demographics
NPI:1689733644
Name:BURNETTE, REXFORD FORREST (PHD)
Entity Type:Individual
Prefix:DR
First Name:REXFORD
Middle Name:FORREST
Last Name:BURNETTE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 TURNPIKE RD
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:NH
Mailing Address - Zip Code:03240-3719
Mailing Address - Country:US
Mailing Address - Phone:603-523-9002
Mailing Address - Fax:603-523-9919
Practice Address - Street 1:5 PLEASANT ST.
Practice Address - Street 2:SUITE A
Practice Address - City:BRISTOL
Practice Address - State:NH
Practice Address - Zip Code:03222-3002
Practice Address - Country:US
Practice Address - Phone:603-744-5519
Practice Address - Fax:603-523-9919
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH893103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30002566Medicaid