Provider Demographics
NPI:1851354732
Name:BURNHAM WOODS CHAMPA & ASSOCIATES
Entity Type:Organization
Organization Name:BURNHAM WOODS CHAMPA & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:BURNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:321-639-4483
Mailing Address - Street 1:1970 MICHIGAN AVE
Mailing Address - Street 2:J 2
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922-5758
Mailing Address - Country:US
Mailing Address - Phone:321-639-4483
Mailing Address - Fax:321-690-0848
Practice Address - Street 1:1970 MICHIGAN AVE
Practice Address - Street 2:J 2
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-5758
Practice Address - Country:US
Practice Address - Phone:321-639-4483
Practice Address - Fax:321-690-0848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 5004101YA0400X
FLMH 6888101YM0800X
FLPY0004573103TC0700X
FLSW 6151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL39755OtherBLUE CROSS BLUE SHIELD
FL39755Medicare ID - Type UnspecifiedMEDICARE GROUP