Provider Demographics
NPI:1770174260
Name:BURTS, CORJAE
Entity type:Individual
Prefix:
First Name:CORJAE
Middle Name:
Last Name:BURTS
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 1:1057 MAYWOOD LN APT 411
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-6573
Mailing Address - Country:US
Mailing Address - Phone:510-584-8575
Mailing Address - Fax:
Practice Address - Street 1:1057 MAYWOOD LN APT 411
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-6573
Practice Address - Country:US
Practice Address - Phone:510-584-8575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician