Provider Demographics
NPI:1205619061
Name:BURTON, ERICA
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:BURTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 NY HIGHWAY 355
Mailing Address - Street 2:
Mailing Address - City:POESTENKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12140-2816
Mailing Address - Country:US
Mailing Address - Phone:518-466-2284
Mailing Address - Fax:
Practice Address - Street 1:283 NY HIGHWAY 355
Practice Address - Street 2:
Practice Address - City:POESTENKILL
Practice Address - State:NY
Practice Address - Zip Code:12140-2816
Practice Address - Country:US
Practice Address - Phone:518-466-2284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1510740211OtherNEW YORK STATE SCHOOL PSYCHOLOGIST PROVISIONAL CERTIFICATE