MEDICARE: ANNE BURNHAM

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	103T00000X	Psychologist	94028779	CA

General Provider Information

NPI Number	:	1427860063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE BURNHAM

Provider Business Mailing Address
First Line	:	16542 KELLOG CIR APT 3
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-8519
Country	:	US
Telephone Number	:	631-829-5821
Fax Number	:

Provider Business Practice Location Address
First Line	:	16542 KELLOG CIR APT 3
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-8519
Country	:	US
Telephone Number	:	631-829-5821
Fax Number	:

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

Provider Enumeration Date	:	01/21/2025
Last Update Date	:	01/21/2025

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