Healthcare Provider Details

I. General information

NPI: 1982083473
Provider Name (Legal Business Name): KERRI BURR MH24947
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4821 S LAKE DR
BOYNTON BEACH FL
33436-5910
US

IV. Provider business mailing address

4821 S LAKE DR
BOYNTON BEACH FL
33436-5910
US

V. Phone/Fax

Practice location:
  • Phone: 978-314-5187
  • Fax:
Mailing address:
  • Phone: 978-314-5187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH24947
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: