Provider Demographics
NPI:1932572898
Name:BURTON DENMARK, ADRYON (PHD)
Entity Type:Individual
Prefix:DR
First Name:ADRYON
Middle Name:
Last Name:BURTON DENMARK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31263
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-0263
Mailing Address - Country:US
Mailing Address - Phone:512-484-5095
Mailing Address - Fax:
Practice Address - Street 1:1587 SANCHEZ ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94131-2329
Practice Address - Country:US
Practice Address - Phone:415-967-2509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-01
Last Update Date:2015-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26676103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling