Healthcare Provider Details

I. General information

NPI: 1649436643
Provider Name (Legal Business Name): GLENDA L. BURR PSY D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GLENDA L GONZALEZ PSY D

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 03/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 VAN NESS AVE STE 503
SAN FRANCISCO CA
94109-7893
US

IV. Provider business mailing address

4104 24TH ST STE 521
SAN FRANCISCO CA
94114-3615
US

V. Phone/Fax

Practice location:
  • Phone: 415-775-7766
  • Fax: 415-775-7730
Mailing address:
  • Phone: 415-775-7766
  • Fax: 415-775-7730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: