Provider Demographics
NPI:1841571171
Name:BURPEE, MONET LASHAWN
Entity Type:Individual
Prefix:MS
First Name:MONET
Middle Name:LASHAWN
Last Name:BURPEE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MONAT
Other - Middle Name:LASHAWN
Other - Last Name:BURPEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1108 S EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2804
Mailing Address - Country:US
Mailing Address - Phone:650-458-0026
Mailing Address - Fax:650-458-0027
Practice Address - Street 1:1108 S EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2804
Practice Address - Country:US
Practice Address - Phone:650-458-0026
Practice Address - Fax:650-458-0027
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA104100000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty