Provider Demographics
NPI:1457517120
Name:BURICK, CARRIE R (MA, ATR, PC)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:R
Last Name:BURICK
Suffix:
Gender:F
Credentials:MA, ATR, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 SOM CENTER RD
Mailing Address - Street 2:D-20
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-2944
Mailing Address - Country:US
Mailing Address - Phone:440-248-5588
Mailing Address - Fax:
Practice Address - Street 1:6200 SOM CENTER RD
Practice Address - Street 2:D-20
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2944
Practice Address - Country:US
Practice Address - Phone:440-248-5588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0501255101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health