Healthcare Provider Details

I. General information

NPI: 1558402719
Provider Name (Legal Business Name): ANDREW WALTER BURKAMP MA, CADC I
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 06/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 WATER ST
SOUTH GLASTONBURY CT
06073-2225
US

IV. Provider business mailing address

2644 SE 50TH AVE
PORTLAND OR
97206-1536
US

V. Phone/Fax

Practice location:
  • Phone: 503-535-1150
  • Fax:
Mailing address:
  • Phone: 503-313-1669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: