Provider Demographics
NPI:1760509038
Name:BURNS, JOHN ERROLL (MA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ERROLL
Last Name:BURNS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6044
Mailing Address - Country:US
Mailing Address - Phone:207-942-7787
Mailing Address - Fax:
Practice Address - Street 1:84 5TH ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6044
Practice Address - Country:US
Practice Address - Phone:207-942-7787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS106103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical