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NPI Code Detail

MEDICARE: MR. JOHN BURBANK M.ED, LCMHC

MEDICARE: MR. JOHN BURBANK M.ED, LCMHC
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
1101YM0800XMental Health Counselor294NH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17706655Y0NH01OTHERNHBHN
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619041274
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOHN BURBANK M.ED, LCMHC
Provider Business Mailing Address
First Line : 1145 SAGAMORE AVE
Second Line :
City : PORTSMOUTH
State : NH
Zip : 03801-5585
Country : US
Telephone Number : 603-431-6703
Fax Number : 603-430-3753
Provider Business Practice Location Address
First Line : 1145 SAGAMORE AVE
Second Line :
City : PORTSMOUTH
State : NH
Zip : 03801-5585
Country : US
Telephone Number : 603-431-6703
Fax Number : 603-430-3753
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2006
Last Update Date : 07/08/2007

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