Provider Demographics
NPI:1790825271
Name:BURNS, CHERYL (BA)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:BURNS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 BAMBERRY LN
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-4044
Mailing Address - Country:US
Mailing Address - Phone:732-610-5481
Mailing Address - Fax:
Practice Address - Street 1:3535 STATE ROUTE 66
Practice Address - Street 2:BLDG 5 SUITE D
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-2622
Practice Address - Country:US
Practice Address - Phone:732-643-4362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health