MEDICARE: EVELYN DAWN BURNETT MASTER

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1982112512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVELYN DAWN BURNETT MASTER

Provider Business Mailing Address
First Line	:	116 LARCH ST
Second Line	:
City	:	SCRANTON
State	:	PA
Zip	:	18509-2802
Country	:	US
Telephone Number	:	570-489-5561
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 LARCH ST
Second Line	:
City	:	SCRANTON
State	:	PA
Zip	:	18509-2802
Country	:	US
Telephone Number	:	570-489-5561
Fax Number	:

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

Provider Enumeration Date	:	01/17/2018
Last Update Date	:	07/08/2025

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