Healthcare Provider Details

I. General information

NPI: 1104940477
Provider Name (Legal Business Name): CASSANDRA MARIE BURCHFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N HIGHWAY 27 STE 4
CLERMONT FL
34711-2411
US

IV. Provider business mailing address

210 N HIGHWAY 27 STE 4
CLERMONT FL
34711-2411
US

V. Phone/Fax

Practice location:
  • Phone: 352-708-6283
  • Fax: 352-363-2496
Mailing address:
  • Phone: 352-708-6283
  • Fax: 352-363-2496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT3215
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: