Provider Demographics
NPI:1760999619
Name:BURNS, JACQUELINE RENE (MA)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:RENE
Last Name:BURNS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:RENE
Other - Last Name:RENEER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:65 METACOMET AVE
Mailing Address - Street 2:
Mailing Address - City:EAST TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02718-1385
Mailing Address - Country:US
Mailing Address - Phone:270-903-9876
Mailing Address - Fax:
Practice Address - Street 1:108 W MAIN ST UNIT 5
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:MA
Practice Address - Zip Code:02766-1248
Practice Address - Country:US
Practice Address - Phone:508-295-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-01
Last Update Date:2018-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health