MEDICARE: DR. ADRYON BURTON DENMARK PH.D.

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	103TC1900X	Counseling Psychologist	PSY26676	CA

General Provider Information

NPI Number	:	1932572898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADRYON BURTON DENMARK PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 31263
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94131-0263
Country	:	US
Telephone Number	:	512-484-5095
Fax Number	:

Provider Business Practice Location Address
First Line	:	1587 SANCHEZ ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94131-2329
Country	:	US
Telephone Number	:	415-967-2509
Fax Number	:

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

Provider Enumeration Date	:	11/01/2015
Last Update Date	:	11/01/2015

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