Provider Demographics
NPI:1932316676
Name:BURNS, BETTY ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:BETTY ANN
Middle Name:
Last Name:BURNS
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 1:25 SLAB CITY ROAD
Mailing Address - Street 2:
Mailing Address - City:LINCOLNVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04849
Mailing Address - Country:US
Mailing Address - Phone:207-789-5373
Mailing Address - Fax:
Practice Address - Street 1:25 SLAB CITY ROAD
Practice Address - Street 2:
Practice Address - City:LINCOLNVILLE
Practice Address - State:ME
Practice Address - Zip Code:04849
Practice Address - Country:US
Practice Address - Phone:207-789-5373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPC207101YP2500X
GUIMF000045106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist