Healthcare Provider Details

I. General information

NPI: 1386258614
Provider Name (Legal Business Name): ADRIENNE M BURR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20377 SW ACACIA ST STE 110
NEWPORT BEACH CA
92660-0781
US

IV. Provider business mailing address

20377 SW ACACIA ST STE 110
NEWPORT BEACH CA
92660-0781
US

V. Phone/Fax

Practice location:
  • Phone: 888-717-9355
  • Fax: 949-287-5439
Mailing address:
  • Phone: 888-717-9355
  • Fax: 949-287-5439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number115436
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number95553
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: