Healthcare Provider Details

I. General information

NPI: 1114123130
Provider Name (Legal Business Name): DEBORAH JANE BURTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 08/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 W BEACH ST
WATSONVILLE CA
95076-4504
US

IV. Provider business mailing address

1400 EMELINE AVE
SANTA CRUZ CA
95060-1976
US

V. Phone/Fax

Practice location:
  • Phone: 831-763-8999
  • Fax:
Mailing address:
  • Phone: 831-454-4170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS9438
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: