Provider Demographics
NPI:1740898972
Name:BURDICK, JEFFREY SHERMAN
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:SHERMAN
Last Name:BURDICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 ARCATA
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-0913
Mailing Address - Country:US
Mailing Address - Phone:951-741-9222
Mailing Address - Fax:
Practice Address - Street 1:4255 CAMPUS DR STE A245
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-8630
Practice Address - Country:US
Practice Address - Phone:951-741-9222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA886851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical