Provider Demographics
NPI:1205427754
Name:BURNHAM, KATRINA (LMSW)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:BURNHAM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 FOX ST
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-2129
Mailing Address - Country:US
Mailing Address - Phone:810-660-8275
Mailing Address - Fax:
Practice Address - Street 1:4070 HURON ST
Practice Address - Street 2:
Practice Address - City:NORTH BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48461-8664
Practice Address - Country:US
Practice Address - Phone:810-270-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical