MEDICARE: MRS. SUZANNE DAWN BURTON LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	PC002629	PA

General Provider Information

NPI Number	:	1174519912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUZANNE DAWN BURTON LPC

Provider Business Mailing Address
First Line	:	330 CEDAR RD
Second Line	:
City	:	HERSHEY
State	:	PA
Zip	:	17033-9302
Country	:	US
Telephone Number	:	717-534-2076
Fax Number	:	415-534-2073

Provider Business Practice Location Address
First Line	:	330 CEDAR RD
Second Line	:
City	:	HERSHEY
State	:	PA
Zip	:	17033-9302
Country	:	US
Telephone Number	:	717-534-2076
Fax Number	:	415-534-2073

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	03/07/2008

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