Provider Demographics
NPI:1023581477
Name:BURNETT, CAROLINE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:
Last Name:BURNETT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8651 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2721
Mailing Address - Country:US
Mailing Address - Phone:414-774-9200
Mailing Address - Fax:
Practice Address - Street 1:8651 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2721
Practice Address - Country:US
Practice Address - Phone:414-774-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-09
Last Update Date:2023-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI670-228106H00000X
WI1375106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist