Provider Demographics
NPI:1952705022
Name:BURNETT, KARISSA ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KARISSA
Middle Name:ANN
Last Name:BURNETT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KARISSA
Other - Middle Name:ANN
Other - Last Name:BURGESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:75 ARLINGTON ST STE 500
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-3986
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:75 ARLINGTON ST STE 500
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3986
Practice Address - Country:US
Practice Address - Phone:617-958-6538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2022-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY61182843103T00000X
MA11534103T00000X
CAPSY33448103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist