Provider Demographics
NPI:1760783443
Name:BURLINGAME, CHERYL LANE (RN, MN, CNS)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:LANE
Last Name:BURLINGAME
Suffix:
Gender:F
Credentials:RN, MN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 MOODY CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-6067
Mailing Address - Country:US
Mailing Address - Phone:805-777-3500
Mailing Address - Fax:
Practice Address - Street 1:72 MOODY CT
Practice Address - Street 2:SUITE 101
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-6067
Practice Address - Country:US
Practice Address - Phone:805-777-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAP302101YM0800X
CA306470163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health