Provider Demographics
NPI:1922372887
Name:BURCROFF, TERI L (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERI
Middle Name:L
Last Name:BURCROFF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 3 BOX 130
Mailing Address - Street 2:
Mailing Address - City:KUNKLETOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18058-9519
Mailing Address - Country:US
Mailing Address - Phone:610-365-8373
Mailing Address - Fax:610-365-8373
Practice Address - Street 1:RR 3 BOX 130
Practice Address - Street 2:
Practice Address - City:KUNKLETOWN
Practice Address - State:PA
Practice Address - Zip Code:18058-9519
Practice Address - Country:US
Practice Address - Phone:610-365-8373
Practice Address - Fax:610-365-8373
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-00-0314103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst