Provider Demographics
NPI:1760750798
Name:BURNETT, LAGRACIA (ME)
Entity Type:Individual
Prefix:MS
First Name:LAGRACIA
Middle Name:
Last Name:BURNETT
Suffix:
Gender:F
Credentials:ME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8612 FORREST AVE.
Mailing Address - Street 2:
Mailing Address - City:PHILA.
Mailing Address - State:PA
Mailing Address - Zip Code:19150
Mailing Address - Country:US
Mailing Address - Phone:267-439-6721
Mailing Address - Fax:215-248-1011
Practice Address - Street 1:8612 FORREST AVE
Practice Address - Street 2:
Practice Address - City:PHILA.
Practice Address - State:PA
Practice Address - Zip Code:19150
Practice Address - Country:US
Practice Address - Phone:267-439-6721
Practice Address - Fax:215-248-1011
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst