Provider Demographics
NPI:1396945416
Name:BURT, ALICE G (BS, CADC)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:G
Last Name:BURT
Suffix:
Gender:F
Credentials:BS, CADC
Other - Prefix:
Other - First Name:IDG
Other - Middle Name:
Other - Last Name:BURT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS, CADC
Mailing Address - Street 1:625 N ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-2296
Mailing Address - Country:US
Mailing Address - Phone:302-656-4044
Mailing Address - Fax:302-656-3439
Practice Address - Street 1:625 N ORANGE ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-2296
Practice Address - Country:US
Practice Address - Phone:302-656-4044
Practice Address - Fax:302-656-3439
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE103TP2701XMedicaid