Provider Demographics
NPI:1811352107
Name:BURLAK, RAINA (MS NCC)
Entity type:Individual
Prefix:
First Name:RAINA
Middle Name:
Last Name:BURLAK
Suffix:
Gender:F
Credentials:MS NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12553 NEW BRITTANY BOULEVARD SUITE 32
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33967-3625
Mailing Address - Country:US
Mailing Address - Phone:239-689-3079
Mailing Address - Fax:239-313-6923
Practice Address - Street 1:12553 NEW BRITTANY BLVD
Practice Address - Street 2:SUITE 32
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3625
Practice Address - Country:US
Practice Address - Phone:239-689-3079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH12032101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health